U&I Spa Inc

130 West 57th Street, Suite 14A
New York, NY, 10019
Phone: 917.214.9910
Email: uandispa@gmail.com

Please answer all questions below and press the [SUBMIT] button on all forms.

1. CLIENT MEDICAL HISTORY FORM

*Do you have or previously had the following? Select YES or NO
I agree that all the above information is true and accurate to the best of my knowledge. I do understand that laser hair removal is not 100% permanent but a reduction of up to 90%. I do understand the cancellation and rescheduling policy and agree to pay the appropriate fees if I do not cancel or reschedule within 24 hours of my appointment date and time. I do understand that taxes, gratuities and shaving fees are not included in any service I purchase. It is common practice to tip 15-20% of the original service price. Please feel free to extend a gratuity as a result of your space experience. Gratuities are accepted in the form of cash or credit card. I do understand that if I fail to shave my appointment will either be rescheduled or an additional shaving fee will apply (starting at $30). All sales are final and non-refundable. However, exchanges can be made for any remaining credit toward other services we provide.
Please be aware that discounted offers (Groupon, Living Social, Gilt, Class Pass etc) are only for first time clients (one-time use). All services in this package of up to 3 sessions will expire after 6 months from purchase date. All services in the package of 6-8 sessions will expire after 1 year from purchase date.

2. CLIENT INFORMATION & HISTORY

In order to provide you with the most appropriate laser treatment we need you to complete the following questionnaire. All information is strictly confidential.

3. FOR OUR FEMALE CLIENTS

Please fill out this section if you are female:
I certify that the preceding medical, personal and skin history statements are true and accurate. I am aware that it is my responsibility to inform the technician, esthetician, therapist, doctor or nurse of my current medical or health conditions and to update this history. A current medical history is essential for the caregiver to execute appropriate treatment procedures.

4. LATENESS, CANCELLATION POLICIES, STATEMENT OF CONSENT & RECITALS

I. Please read and initial all lines.
I do understand our lateness, cancellation and rescheduling policy is as follows:
Please arrive at least 5 minutes before your scheduled time. Delayed arrival will limit the time of your experience, reducing the effectiveness of your treatment and the expectations of your visit. In consideration of other guests, service time will not be extended for delayed arrivals. As we are by appointment only kindly give 24 hours advanced notice from your scheduled appointment time to cancel or reschedule. Failure to provide such notice will result in a $30 fee for standard services or a $60 fee for full body services being charged to the card listed on your account. If you do not agree to pay the fee your appointment will be rescheduled in six weeks from the date of your cancellation, which will result in losing one session. A valid debit or credit card must be kept on file at all times. Unauthorized charges will not be made to your account and your billing information will not be shared. I duly authorize U&I Spa INC to perform the Alma Soprano XL and/or Galaxy Laser Pro laser hair removal procedure and any other measures, which in their opinion, may be necessary.
II. I understand the Alma Soprano XL and Galaxy Laser Pro laser systems are intended for hair removal and that clinical results may vary with different skin types, hair color, age and body location. I understand there is a possibility of rare side effects, such as scarring and permanent discoloration; as well as short-term effects, including redness, mild burning, blistering, temporary bruising and discoloration of the skin, such as hypo pigmentation (decrease in skin pigment) or hyper pigmentation (increase in skin pigment). These effects have been fully explained to me. I understand that laser hair removal is not 100% permanent and is in fact a reduction of up to 90% with minimum six sessions.
III. I understand that to achieve maximum results the protocol prescribed should be adhered to. The treatment schedule is designed to maximize the results during treatment of each hair cycle. If for any reason the schedule cannot be adhered to, I understand that the total percentage of hair loss could be affected. In addition, hair follicles that are dormant now may become active during or after my treatment program and additional treatments may be necessary. I also understand that I will have to pay for these additional treatments. I understand that treatment by the Soprano XL and Galaxy Laser Pro laser hair removal systems involve a series of treatments and the fee structure has been fully explained to me. I certify that I have been fully informed of the nature and purpose of the procedure, expected outcomes and possible complications, and I understand that no guarantee can be given as to the final result obtained. I am fully aware that my condition is of cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so.
IV. I confirm that I am not pregnant at this time and I will inform U&I Spa INC if become pregnant in the future so I can stop all laser treatments immediately.
I confirm that I have not taken Accutane within the last 6 months and that I do not have a pacemaker or internal defibrillator.
I understand that taxes and gratuities are not included in any service I purchase. I do understand that gratuities are based on regular single session prices and not package or discounted prices.
V. I understand I need to stop tweezing, waxing, bleaching, using depilatories or any substance/ medication that will damage the hair follicle. I understand I need to FULLY shave the hairs within 24 hours of my scheduled appointment time and failure to do so will result in my appointment being rescheduled or an additional shaving fee will apply.
I understand excessive sun exposure needs to be avoided two weeks before and two weeks after each treatment. For optimal results, I should attempt to maintain the same skin tone throughout the treatment process. Sun exposure, tanning bed exposure or the use of tanning creams could result in a less effective treatment and the technician choosing not to perform the treatment.
I have read and understand this agreement and all my questions have been addressed and answered to my satisfaction. I consent to the terms of this agreement.

5. FOR USE IF RELEASOR IS UNDER AGE OF 18

Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all terms of this document, as set forth above