Please Submit a Spa Consent Form Prior to Your Appointment

Welcome!

Our goal is to deliver the most pleasurable spa experiences. In order to customize your experience and assure your satisfaction and safety, please COMPLETE the questions below so the spa’s professional team can deliver the best spa experience possible. Thank you.
Spa Consent Form
Participant’s Name
Participant's Name
First Name
Last Name
Address
Address
City
State/Province
Zip/Postal
I would like to receive emails containing information about specials and events
Aromatherapy is offered for all massages. Please choose a scent for your service.
Service Enhancements: if you choose to add an enhancement to your service. Some enhancements may not be available with your service. All enhancements are an additional fee:
For Massage: It is not recommended to engage in certain treatments where specific medical conditions exist. Please check off any conditions that apply to you, and/or you have a personal history of:
Women: Are you pregnant?
Have you ever experienced a Professional Massage before?
For Facials Service Only: Skin type?
What are some of your skin care concerns?
Are you currently using Retin / Alpha Hydroxy Acids?
Have you ever experienced a Professional facial?
TERMS AND CONDITIONS

I understand that the service I receive is provided for the basic purpose of relaxation and relief of muscular tension. If I experience any pain or discomfort during the session, I will immediately inform the technician so that the pressure and/or strokes may be adjusted to my level of comfort. I further understand that massage should not be construed as a substitute for medical examination, diagnosis, or treatment. I understand that the technicians 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 as such. Because massage should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the technician updated as to any changes in my medical profile during the session and understand that there shall be no liability on the technicians part should I fail to do so. I understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session. I also understand that the technician reserves the right to refuse to perform the service on anyone whom he/she deems to have a condition for which the service is contraindicated. In consideration for receiving The Spa at the Lakehouse Inn services, I hereby release, waive, discharge, and covenant not to sue The Spa at the Lakehouse Inn,  and each of their  owners, officers, agents, servants, and employees from any and all liability, claims, demands, actions, and causes of action related to any loss, damage or injury that may be sustained by me or property belonging to me, whether caused by negligence or otherwise, while participating in such activity or while on The Spa at the Lakehouse Inn premises.  I am fully aware of the risks involved and hazards connected with spa treatment, and I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, that may be sustained by me, or any loss or damage to property owned by me as a result of being engaged in such activity, whether caused by the negligence or otherwise.

Participant’s Name
Participant's Name
First Name
Last Name
If you are a child of 16 years or younger you must have a parental consent for your service. Are you under the age of 17?
Would you like to be present in the room during servie?
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