Please fill out the New Client Form for Melissa.
Are you currently under treatment for, or have you ever had any of the following? (please check all that apply)
EczemaHIV/AIDSSkin CancerDiabetesAutoimmune DisorderNone
I have completed this information to the best of my knowledge. By signing this form, I understand and agree the
services provided are not a replacement for medical or psychological care. This information provided is not prescriptive
or diagnostic in nature, and it is for educational purposes only. I understand treatment may not be provided where
contraindicated, and I agree to keep each technician updated as to any changes in my medical profile. I also understand
that any elicit or sexually suggestive remarks or advances made by me will result in immediate termination of the
treatment and I will be liable for payment of the scheduled appointment.
I hereby release Serendipity Spa from any and all injuries and damages, whether known or not, in which may in here and
after appear to develop arising from the services and/or products provided to me in my presence on the premises.
I have read the information above and understand Serendipity Spa, nor any of its agents, are responsible for any
damages, injury, or death that might result from my presence around or participation in spa related activities. I
knowingly assume all risk stemming from my spa related activities.
I am executing the release solely in reliance upon my own knowledge, belief, and judgment, and not upon any
representations made by the party release: Serendipity Spa
I have read the release and understand its terms and voluntarily sign below
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