New Client’s Consent Form

Please read thoroughly and consent to each box prior to your service.

New Client's Consent Form

I hereby request and consent to the performance of massage, skin care, body treatment, waxing, and related services by rA Organic Spa Inc. (“ rA Organic”) and its employees, or independent contractors.

rA Organic employees and independent contractors are hereafter referred to as “associates”.

rA Organic associates do not diagnose illness, injuries, disease, nor any medical condition.

rA Organic services are not a substitute for medical treatment and that I should consult with a physician for any physical problem or skin condition I may have.

As with any massage, body treatment, skin care service, waxing, or spa service there are some risks associated with treatments. rA Organic associates are not able to anticipate or explain all of the risks and complications.

have informed rA Organic of all my known medical conditions.

There are medication and topical product contraindications with waxing. rA Organic does not recommend receiving any waxing service if you are currently taking any prescription medications or using topical products that make the skin more sensitive including, but not limited to:

Accutane (Acne medication) – You must be off this medication treatment course a minimum of one (1) year prior to waxing.
Differin Gel
Retin A/ Retinol
Glycolic Acid/ Alpha Hydroxy Acids
ProActive
Benzoyl Peroxide
Salicylic Acid/ Beta Hydroxy Acids
Antibiotics

I assume all health risks from any service received at rA Organic, including, but not limited to, any bodily injuries and adverse skin reactions. I release rA Organic from any liability resulting from any service received at rA Organic Spa. *

have informed rA Organic of all my known medical conditions.

First Name

Last Name

Email

Date

Your Signature

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