Confidential Client Intake Form (Page 2 of 2) in pdf

I confirm (to the best of my knowledge) that the information I have provided is accurate and complete. I have not

withheld any pertinent information that may be relevant to my treatment and/or the results thereof. I am aware that

there are some inherent risks associated with skin care & body work services including, but not limited to: allergic

reaction, irritation, redness, soreness, etc. By signing below, I further agree that I will not hold Natural Elements Spa

& Academy, Inc., Spa’s affiliates or any of its employees responsible should there be any unfavorable outcome or result.

I also understand that massage is designed to be a health aid and is in no way a substitute for medical care. Information

exchanged during a massage session is educational in nature, but not diagnostic

Cancellation Policy and Return Check Fee

Our certified spa & salon professionals take extra special time and care in preparing for your appointment.

Please respect our time as we respect yours. If you cannot make your appointment, we require 24 hour

notice for all cancellations. A $15.00 rebooking fee or a charge of 100% of the service will be applied to

any appointments cancelled without 24 hours’ notice. If rebooking at the time of cancellation you will

be charged a $15.00 rebooking fee only. No-show appointments will be charged 100% of the service.

Gift Certificates will automatically be charged according to the above guidelines. Return Check Fee

is $35.00.

If you are a new client we ask that you arrive 15 minutes prior to your spa service appointment. All spa

package appointments should arrive at least 20 min prior to appointment time to make necessary product and

lunch selections for your customized spa experience. If you are late for your appointment we will not be

able to accommodate your full session time due to other clients following appointments. The Full value of

the treatment will be charged.

We appreciate your time in responding to our DemandForce, “How was your experience” survey. We

take your comments very seriously and the information is used to continuously improve our service to

you!

Ask about our various booking options!

Signature_________________________________________________

Date________________

________________________

___

Look Better, Feel Better Membership

Join Today & Receive a $45 Introductory 60 Minute Swedish Massage Session

OR Receive a $65 Introductory Facial Session

$59

Monthly Massage only

$19 a time of service:

Upgradable Exchange

options for an additional



60 Minute Facial Session



60 Minute Spa Capsule Session



Partial Foil, Hair Cut & Style



90 Minute Massage Session



Signature Foot Ritual & Express Nail Ritual

Additional Membership Benefits

15% OFF ANY Other / Additional Spa & Salon Services [within same month]

10% OFF on ALL Regular Priced Retail Products

10% OFF to Family & Friends when you bring them in with you on Wed. & Thurs.

12 Month Commitment for $59 per month

NESS Memberships will require a MC or VISA to be on file for monthly billing for the length of the contract. All

NESS Memberships will be billed on the 1

of every month from the date of enrollment. Contracts for

memberships may not be cancelled unless Military involvement, and are non-transferable. Each monthly

membership service expires at the end of each month. [Discounts do not apply to consigned products or

independent wellness practitioners providing services within Natural Elements Spa & Salon] Not to be used in

conjunction with any other promotion, points, coupon, gift card, or spa finder.

*Must be a member on day of service to receive introductory prices.

Confidential Client Intake Form Page 2

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