Client Consent Forms

iTouch Spa

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Home
ABOUT
SPA SERVICES
EYELASH EXTENSIONS
WEDDINGS
SPA PARTY
PRODUCTS
PHOTO GALLERY
CONTACT

Client Consent Form

Please fill out consent form before your spa service.

Also fill out the Covid 19 Screening Questions:

Mandatory every client wear a mask.

Upon arrival, you will be asked to wash your hands at the bathroom sink and we will also have hand disinfectant rub available to use.

All questions with (*) must be filled out. Only fill out questions pertaining to services you will be receiving.

Name*

Telephone*

Email Address*

Date of the Service MM/DD/YYYY*

Covid 19 Question 1: Do you have any cold or flu-like symptoms?*

NoYes (If yes, please stay home and we will have reschedule your appointment. Thank you for understanding).

Covid 19 Question 2: Have you returned from travel (including travel within Canada) in the last 14 days OR had *exposure to a confirmed positive case of COVID-19.*

No Yes (If yes, please stay home and we will reschedule your appointment. Thank you for your understanding). Please continue answering the consent form even if you answered "Yes" to all the Covid 19 screening questions.

Option 1Option 2

How did you hear about us?*

What services are you getting done today?*

FacialWaxManicurePedicureEyelash ExtensionsEyelash liftEyelash lift and TintEyelash tintEyebrow tintMassage

Do you have any allergies to cosmetics, skin care, food or Drug?*

NoYes(if yes please go to next question)

Choose if you are effected by or have of the following:*

AsthmaCardiac problemsDiabeticEczemaEpilepsyFever BlisterHeadaches-ChronicHapatitisHerpesHigh Blood pressureImmune DisordersLupusMetal bone, pins, or plates.PacemakerPsychological problemsSinus ProblemCulitisSkin DiseasesNot applicable

Indicate other illnesses not mentioned above (if none please put N/A)

FACIAL ONLY: What is your skin type?

What is your skin care routine (Please select all that applies)

SoapCleansing milkCleansing foamCleansing gelScrubMaskTonerserumDay creamNight cream

What areas of concern do you have regarding your skin? (Select all that apply)

Breakout/AcneBlackhead/WhiteheadsUneven skin toneSun DamageExcessive oil/ShineWrinkles/FinelinesDull/Dry SkinRosaceaRedness/RuddinessBroken CapillariesDehydratedSun damage/Brown Spots

WAX ONLY: (Please select all that applies)

Treated for Skin Cancer?Used Alpha Hydroxy Acid or Glycolic in the past 48/72 hours?Using Retin A, Renova or Acutane or Oral Retin A?Do you have allergies to latex?Are you using any other skin thinning products and/or drugs?Are you exposed to sun on a daily basis, or are you considering spending more time in the sun soon?Do you currently have any open sores, wounds, or irritated skin on or around the area to be waxed?

Read the before and after of waxing, Please Click on the link at buttom of the page.

YES, I will read the before and after wax

Consent*

I release Itouch Spa of any and all Liability.

MASSAGE ONLY: What is the purpose of your massage?

HeadacheInflammationMuscle CrampAnxietyFatiqueInsommiaStressForgetfulness

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Thank you for filling out the consent form. Your information is safe and kept confidential. You will be asked to sign the form when you come in for your appointment.

PLEASE NOTE that waxing does have side effects such as skin removal, redness, swelling, tenderness, etc and that anyone showing signs of redness, rashing, open or abraded skin, psoriasis or Eczema cannot receive waxing services. Anyone having just received a microdermabrasion treatment or an acid peel cannot have a waxing service to the same area. Anyone with a history of Herpes Simplex I or II has been advised that waxing services may cause an outbreak to re-surface.

Link to the Before and After Wax

https://www.itouchspa.ca/preparing-for-a-brazillian

Contact Information

iTouch Spa

Phone: 613.276.2209

Email: [email protected]

Address:

346 Duval Lane, Orleans, ON

Hours of Operation

By Appointments only

Mon-Thu: 9:30 am-7:00 pm

Saturday and Sunday: Closed