Consultation Form

Client Information

 

Your Health

 

Your Skin

 

Exfoliation History

 

Moisture Hydration

 

Capillary Activity

 

Oil Secretion

 

Nerve Activity

 

Female Clients Only

 

Male Clients Only

 

Terms & Service Agreements

  • I understand, have read and completed this questionnaire truthfully. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. I agree to pay the posted schedule prices on www.meggrose.com and I release MeggRose.com from liability and resume full responsibility thereof. Disclaimer of Liability. I agree that MeggRose.com and each of their respective employees, officers, directors, shareholders, members, partners and agents will NOT be liable for any accident, or injury, including, without limitation, personal, bodily or mental injury, economic loss or any damages to me, whether resulting from negligence or otherwise resulting from my participation in any services or products. Release In exchange for this service and other good and valuable consideration, I and each of my heirs, executors, administrators, agents and assigns , hereby release MeggRose.com and employees, officers, directors, shareholders, members, partners and agents, in their corporate and individual capacities from any and all claims, demand, losses or causes of action that may have accrued as a results of my participation in any product or service provided to me and/or as result of my use of MeggRose.Com facility.
  • You will be presented a copy of this form for your signature to verify that it is you who filled out the form and is aware of MeggRose.com Terms and Service Agreements. For guests under the age of 18 years old, a parent or guardian will be responsible for reading, acknowledging and signing this consent and release for their child, as well as being required to remain on the spa premise during any procedure. No services will be performed on anyone under the age of 14.
 

Verification