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Guest registration form

All information is confidential

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:


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.

Pictures will occasionally be obtained for our records. In the event a picture is used for educational or marketing purposes, identifying features will be removed. Please initial to acknowledge this notice.

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.

Given the above, I understand that response to treatment varies on an individual basis and that specific results are not guaranteed. I also agree to hold harmless and release Helen’s Haven and Valorie Ammann,MD , its officers and its employees from any liability for any condition or result, know or unknown that may arise as a result of any treatment that I receive.