Facial Intake

General Information

Name(Required)

First Last

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mobile Number(Required)

Email(Required)

Emergency Contact(Required)

Emergency Contact Phone Number(Required)

Your Occupation(Required)

Visit Expectations and History

What is the reason for your visit today?(Required)

What special areas of concern do you have?(Required)

What conditions would you like to improve? (check all that apply)

Acne Scarring

Acne

Age Spots

Enlarged Pores

Fine Lines and Wrinkles

Hyperpigmentation

Broken Capillaries

Stretch Marks

Surgical/Facial Scars

What is your present skin regimen? (check all that apply)

Cleanser

Masque

Exfoliation

Toner

Moisturizer

Sunblock Daily

Have you had any of the following services?

Peels

Facial Surgery

Botox

Laser Resurfacing

Microdermabrasion

Cosmetic Surgery

Collagen Injections

If you have had any of the previous, how recently?

Are you under treatment for any current skin conditions by a Dermatologist?(Required)

Yes

If yes, for what?

What medications/hormone replacements/vitamins do you presently take?(Required)

Have you ever used any of the following?

Accutane

Renova

Differin

Hydroquinone

Retin-A

Topical Antibiotics

Tazorac

Alpha Hydroxy Acids

If yes, when and for how long?

Do you have a metal implant?(Required)

Yes

Do you have a pacemaker?(Required)

Yes

For Women

Are you pregnant or breastfeeding?

Yes

Maybe

Life and Today’s Visit

In an effort to fully customize your experience today, which scent journey would you like to have?

Relax: Lavender and chamomile

Restore: Lemongrass, peppermint, spearmint, and chamomile

Rejuvenate: Tulsi, cardamom, and fennel

How is your stress level?(Required)

What are your skin care goals for today?

What are your overall skin goals?(Required)

Do you feel you can completely detach from the outside during this service by leaving all electronic devices in a locker?

Yes

Is there anywhere you do not like to be touched?

Scalp

Shoulder

Hands

Neck

Arms

Chest/Decollete

What size robe would you like during your service?(Required)

Policies

Refund Policy:
It is our mission to provide you with the highest-quality of skin and body care products with your services. In fact, you may like these products so much that you wish to use them every day in your own home! In the event you purchase any of our spa products for home use and find them to be defective, we will exchange any products within 14 days of purchase, provided a receipt is presented. Unfortunately we cannot provide cash refunds for returned products. Instead, a spa credit will be provided for any returned products to be used on any other products or spa services available at Drift Spa.

Running Late:
If running late, please understand that every effort will be made to still deliver the service. However, appointments may have to be rescheduled or shortened.

Cancellations:
Your spa treatments are reserved especially for you. We value your business and ask that you respect the spa's scheduling policies. Should you need to cancel or reschedule, please notify us at least 48 hours in advance. Any cancellations with less than 48 hours of notice are subject to a cancellation fee amounting to the cost of the scheduled service. Guests who miss their appointments without giving any prior notification will be charged in full for the scheduled service. We recognize the time of our guests and staff is valuable and have implemented this policy for this reason.

When you miss an appointment with us, we not only lose your business, but also the potential business of other guests who could have scheduled an appointment for the same time. Additionally, many times our staff will be functioning in an "on call" status and may have traveled to the spa specifically for your service. For these reasons we are obligated to compensate our staff for their time as well as make up for the lost revenue.

When you schedule your appointment with us, you are agreeing to these policies. All services require a credit card or gift certificate to guarantee a reservation, so please have your credit card and/or gift certificate ready when booking.

Consultations:
All services begin with a thorough consultation—the most important part of the experience. We make every effort to listen and discuss exactly what our guests are expecting. As wishes are discussed, we ask our guests to voice any issues, concerns, allergies or medical conditions—we’re here for you and want you to be 100% satisfied. Our service providers will also offer product recommendations, as well as discuss routine maintenance. Before the service is performed, our skin shamans will discuss the process as well as the products that will be used.

Cell Phones and Electronic Devices:
We have created an atmosphere of relaxation and zen for all guests. A major part of our ritual is for you to disconnect from all outside distractions so you can connect with your mind, body and soul. For this reason all cell phones and other devices need to be turned off and kept in your locker in the restroom area.

Miscellaneous and Payments:
Drift Spa is not responsible for lost or stolen items or items left behind. Visa, MasterCard, American Express and Discover are all accepted methods of payment. You will be asked to give your credit card upon booking and your card will be charged the day of for all services provided, as well as a 20% service fee. You will not be presented with a bill at time of service to allow for as relaxing an experience as possible.

I have read and understood all of the foregoing information.(Required)

Yes

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