Guest registration form

All information is confidential

Helen's Haven - Guest Form

Personal history:

(We do not sell or disclose this information to anyone.)

If referred by a friend/family member please give us their name as we offer discounts for referrals!


Medical history:


Allergies:

Medications:

For waxing clients:

please let us know with each visit if you are using anything topical from your doctor.

For women only:

Check all that apply

For men only:

Check all that apply

Esthetic history:

Check what you have experienced:

Sun History:

For Esthetic clients:

For massage clients:

For Acupuncture Clients:

I understand that Acupuncture methods used may include Acupuncture, electrical stimulation, cupping, Chinese herbal medicine & nutritional counseling.

I understand that cupping therapy will leave bruise-like marks that will last several days depending on the severity of my condition. While most marks fade and disappear after a few days, there are times when marks could take up to 15 days to clear and in rare cases, it has been reported that marks have taken up to 21 days to fully clear. These areas of bruising or discoloration are typically not painful, but can on occasion have soreness.

Policies, consent and Waiver


Appointments/cancellations/no shows

  • Due to the popularity of our unique services, we highly recommend you make your reservation in advance.
  • Due to our intimate size, cancellations of less than 6 hours notice will incur charges equal to 50% of the service booked or one session will be redeemed for any prepaid treatments.
  • Any no shows will incur a 50% charge.
  • Please arrive 5-10 minutes prior to your reservation to allow time for check-in and a few moments to relax. Appointments cannot be extended due to late arrivals and will shorten the duration of the service.

Skin Sensitivities

  • To avoid adverse reactions, please notify us of any medications you are using, including anything from a dermatologist and remind us of this prior to each service. We would rather err on the side of caution.
  • If you have any sensitivities or allergies to products or ingredients, please remind your esthetician each time prior to your service. Once again, we would rather be overly cautious than overconfident.

Other Policies

  • We recommend you not bring valuables with you for your treatment. We are not responsible for lost or misplaced items.
  • Gift certificates may be transferred, but not refunded.
  • A $15.00 charge will be incurred for return checks.
  • Price lists are available at the front desk.
  • Merchandise credit or exchanges given upon approval.
  • Unfortunately, cash refunds cannot be given.
  • We reserve the right to refuse service to any individual.

I acknowledge that the practice of skin care including micro-current treatments, microdermabrasion, ultrasound treatments, LED treatments, chemical peels, enzyme peels, facials, lasers, IPL, massage therapy and body treatments, and other various beauty treatments is not an exact science and that no specific guarantees can or have been made concerning the expected result. I understand that some clients experience more change and improvement than others. In virtually all cases, multiple treatments are required in order to realize a difference.

I also understand that the following risks and hazards may occur in connection with any particular treatment – included but not limited to: unsatisfactory results, poor healing, discomfort, redness, blistering and scarring. I understand that even though precautions may be taken in my treatment, not all risks can be known in advance.

I verify that all information is correct and current to the best of my knowledge. I understand that any information provided is for safety purposes and will be kept strictly confidential. I hereby give my consent to receive massage, skincare or acupuncture services and/or other bodywork or treatment (the “Services”). My health and safety with respect to such Services and Facility are my sole responsibility. My decision to receive Services from Helen’s Haven or Valorie Ammann, MD, Linda Manning Lac or Lashed by Ronnie is voluntary, and I know of, understand and assume any and all the risks associated therewith.

I agree to all Helen’s Haven, Valorie Ammann, MD, Linda Manning Lac, and Lashed by Ronnie policies, including cancellation, no-show and sick policies.

I agree and acknowledge that any use of Helen’s Haven, Valorie Ammann, MD, Linda Manning Lac, and Lashed by Ronnie facilities and/or amenities is optional and is done so at my own risk.

In exchange for receiving Services from Helen’s Haven, Valorie Ammann, MD, Linda Manning Lac, and Lashed by Ronnie, I, for myself and on behalf of my heirs, executors, administrators and personal representatives, hereby waive, release, discharge and hold harmless Helen’s Haven, Valorie Ammann, MD, Linda Manning Lac, and Lashed by Ronnie, its members, officers, employees and agents from any and all liability for any and all injuries, damages or claims relating to or resulting from receipt of the Services, now or in the future, foreseen or unforeseen. Further, I will indemnify and hold Helen’s Haven, Valorie Ammann, MD, Linda Manning Lac, and Lashed by Ronnie, its members, officers, agents and employees, harmless from and against any and all claims, rights, damages, liabilities, losses, costs and expenses (including reasonable attorneys’ fees) arising from or in connection with any injuries to other persons or damage to property caused by or attributed to me.

I acknowledge that I have read, and understand, the release and indemnification provisions set forth in the preceding paragraph, and agree to such terms.


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