Please take a moment to carefully read the following information and sign where indicated. If you have a specific medical condition or specific symptoms massage, bodywork, aesthetic skincare treatments or waxing services may be contraindicated.
A referral from your primary care provider may be required prior to service being provided.
I understand that massage, bodywork or facials I receive are provided for the basic purpose of relaxation and relief of muscular tension. It is my choice to receive waxing services. I understand that the information given above is strictly confidential and will be used for no other purpose than to assist the practitioner customizing my service. If I experience any pain or discomfort during this session, I will immediately inform the practitioner so that the pressure and/or strokes may be adjusted to my level of comfort. I further understand that massage or bodywork should not be construed as a substitute for medical examination, diagnosis, chiropractor or other qualified medical specialist for any mental or physical ailment that I am aware of. I understand that practitioners are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed such. Because massage, bodywork, or facials should not be performed under certain medical conditions, my signature below indicates that I have stated all my known medical conditions, and answered all questions honestly. I understand that it is my responsibility to keep the practitioner updated as to any changes in my medical profile and understand that there shall be no liability on the practitioner's part should I fail to do so. I understand that failure on my part to disclose information could result in injury and/or illness and I hereby release Bella Vita Boutique Spa from any claims resulting from such. I also understand that any illicit or sexually suggestive remarks or advances made by me are considered sexual harassment and will result in the immediate termination of the session, and I will be liable for payment of the scheduled appointment.