Facial Services Liability Waiver

Release of Liability Waiver for Facial, Microdermabrasion and or Peels


Client History

1. Have you undergone any surgery in the last nine months? *
2. Do you have any of these health conditions in the past or present?
4. Do you:
5. Age: *
6. How much plain water do you consume daily? *

Skin Condition

1. Do you experience skin break-outs? *
2. Do you ever experience these conditions on your skin?
3. If you sunbathe, do you use sunscreen / sunblock?
4. Do you burn easily in moderate sunlight? *
5. Do you have a tendency to redness? *
6. Have you ever had a reaction to the any of the following?
8. What types of skin care products are you currently using?
9. What temperature of water do you cleanse with?
10. What type of massage do you prefer?
11. What type of massage lotion do you prefer?


I confirm to the best of my knowledge, that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment. All information will be kept strictly confidential. I agree to hold Spa Escape, and its employees harmless for any and all side effects, which may result from my informed decision to receive a facial, microderm, or peel treatment. I have read and understand the above release of liability waiver and hereby give my consent to receive the facial, microderm, or peel treatment.