Name______________________________________________________________________________________

Address_________________________________________________________________________

Phone_______________________________Email_______________________________________

DOB___________________.Referred By_____________________________________________

Cancellation Procedure

Our schedule stays consistently busy and we ask that each client be understanding that these time slots are very valuable. It is because of this that we are creating a cancellation policy.

A credit card will be kept on file for ALL APPOINTMENTS and ALL CLIENTS.

You will be CHARGED FULL PRICE for any service that you NO SHOW.

Initials______

You will BE CHARGED 50% of any service that you:

- Give less than 48 hours cancellation notice

- Arrive more than 10 minutes late to an appointment (& requires the appointment to be rescheduled) Initials______

Client Record

Do you have any known allergies or sensitivities to cosmetics, solvents, adhesives, or tapes? Yes___________No_________ If yes please describe:

_____________________________________________________________________

Have you used any Alpha Hydroxy Acid (AHA) or glycolic products in the past

48-72 hours? Yes__________ No__________ If yes please describe:

______________________________________________________________________________

Are you currently or in the past 6 weeks using Retin-A, Renova or Accutane (an

oral form of Retin-A)? If yes please circle which one. Yes__________ No__________

Are you currently using any type of medication, antibiotics, or have any conditions that may interfere with the service being offered? Yes__________ No__________

If yes please advise:

____________________________________________________________________________________________________________

Please note that there may be side effects to the services being offered.

By signing you certify that you have read, and fully understand the above questions and accept any risks associated with services offered by Primp Spa LLC;

Client Signature:______________________________________________________________

Photo Consent

Client Name: ________________________________________________ Date: _____________________

I consent to the reproduction and use of my photo(s) (without identifying client name or marks), with the consent of the producing agent(s), Jettie Watkins, Primp Boutique Spa LLC and Pink West Salon ONLY. Consent shall involve the use of my photos for any educational purposes, including instruction, display to professional organizations, websites, social media and advertising thereof.

This consent, as stated above, shall be a continuing consent for all procedures, past, present & future. Written notice must received from the client asking to discontinue use. (60 days written notice required)

I give Jettie Watkins and Primp Boutique Spa LLC. permission to use my photo(s) as marked below.

Full Face _______ Initials

Eyebrows w/Eyes Only  _______ Initials

NO PHOTOS_______Initials

Client’s Signature: ___________________________________ Date ___________

Instructor/Technician: ________________________________ Date: ___________