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    GG’s Spa
    Email Address:
    Street Address:
    Zip Code:
    Primary Phone:
    Cell Phone:
    _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
    Do you wear contact lenses? YesNo
    Have you ever had an adverse reaction to a cosmetic product? YesNo
    Primary reason for your appointment today:
    How often do you receive facials?
    Body treatments?
    Your normal skin care routine:
    Special concerns you have about your skin:
    Have you had any of these:
    If Other:
    Have you had any surgery? If yes, please describe:
    Do you have any condition that could affect service options?
    Do you have food allergies? YesNo
    Latex allergies? YesNo
    Any other allergies?
    Are you currently taking any prescription medications? If yes, please list name and reason for medication:
    Are you currently pregnant or undergoing fertility treatments? YesNo
    Is there anything your technician should be aware of before your treatment?

    In consideration for receiving GG’s Spa services, I hereby release, waive, discharge, and covenant not to sue GG’s Spa,
    Its owners, affiliates, 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 GG’s Spa 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, which may be sustained by me, or any loss or damage
    To property owned by me as a result of being engaged in such an activity, whether caused by the negligence or otherwise.

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