Hands & Feet
Ambika Herbals CBD Collection
Clear My Head
WholeMade Bath Co
This intake form is for clients that have already reserved with us. If you would like to book a service please call us at 970-547-8701.
Date of Birth
Are you wearing contacts?
Are you pregnant?
How many weeks?
How did you hear about us?
For Waxing Services
Have you had any of the following symptoms within the last 72 hours?
Shortness of Breath/Difficulty Breathing
Congestion or Runny Nose
Loss of Taste or Smell
Rash: Open Wounds; Warts (Hands/Feet)
I will keep my face covered for the duration of the service and in indoor areas open to the general public whenever six feet of separation cannot be maintained. Please initial:
I have not used a scrub, Retin A, Retinal OTC, take-home microdermabrasion, glycolic peel, peels, exfoliated or tanned in the last 72 hours. Please initial:
In the last 7 days, I have not had any Botox, Fillers, microdermabrasion, or chemical peels. Please initial:
I have been off Accutane for at least 8-12 months. Please initial:
Are you sunburned or windburned?
For Bikini, French, and Brazilian waxing: I am not currently in my menstrual cycle. Please initial:
Please Note: For your safety, we are unable to accommodate these services during your menstrual cycle.
I do not have any open skin lesions, or active herpes outbreak (cold sore or genital). Please initial:
Please Note: For the safety of both you and your technician, we are unable to accommodate waxing services during an outbreak.
Are you diabetic or do you have circulatory problems?
Are you currently on a blood thinning medication?
Some possible side effects of waxing include redness, swelling and pimples, but are temporary and will generally fade within 72 hours. Please initial:
I agree to adhere to safety post care including: no peels, exfoliation, tanning, steam rooms, hot tubs. and/or pools for at least 48 hours. Please initial:
I am at least 18 years of age or I have parental consent signed below. Please initial:
Waxing Treatment Consent
I certify that the above information is complete and correct. I will keep the therapist informed of any changes as they occur. I will be responsible for making payments on any appointment which is not cancelled 24 hours in advance. I understand that Breckenridge Grand Vacations, Soothe Spa, and any therapist working at this business will not be liable for any injuries or loss sustained to myself or property at this location, and that the procedures I am receiving are not intended to be a substitute for professional medical treatment for any condition.
I agree to the policy.
Waxing Treatment Payment
I authorize Soothe Spa to charge the amount of my service to the credit card on file.
I understand that if I do not provide the appropriate cancellation window which is 24 hours in advance of my service my card will be charged for the full cost of service.
I agree to the policy.
I would like to include a gratuity for my service provider:
AT THE GRAND LODGE ON PEAK 7
1979 Ski Hill Road
Breckenridge, CO 80424
Open every day, 8 a.m. - 10 p.m.
The soul of Breckenridge Grand Vacations is creating smiles!
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