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Intake & Consent Waiver

Welcome to Zen Head Spa. Please complete the following waiver form before you head spa session. Clients under 18 years of age must have this form completed and signed by a parent or legal guardian.

Full Name

Phone Number

Appointment Time

Date Of Appointment

Services

Any Add-On Services

Any Add-On Services
A
B

HEALTH & SCALP QUESTIONNAIRE

Please check any conditions that apply and please inform our staff of anything we should be aware of.

Please check any conditions that apply and please inform our staff of anything we should be aware of.

Other (please specify)

CLIENT CONSENT & LIABILITY WAIVER

Client Consent & Liability Waiver

I voluntarily consent to receive the services selected or otherwise provided by Zen Head Spa and understand the nature and purpose of the treatment.

I understand these services are intended for relaxation and cosmetic wellness purposes only and are not medical treatments.

I confirm that I have disclosed all known medical conditions, allergies, sensitivities, injuries, scalp conditions, or recent cosmetic treatments that may affect my service.

I understand that certain treatments may involve water, essential oils, massage pressure, steam, exfoliation products, or hair/scalp products that could potentially cause irritation or discomfort.

I acknowledge that results may vary depending on individual scalp, skin, and hair conditions.

I understand that if I experience discomfort, irritation, dizziness, pain, or any unusual reaction during the service, I will immediately notify my service provider.

I understand Zen Head Spa reserves the right to refuse or discontinue services if a condition appears unsafe for treatment.

I agree to pay for all scheduled services and understand that services are non-refundable once they have begun or been completed, except where required by law.

I release and hold harmless Zen Head Spa, its owners, employees, contractors, and service providers from liability for any reactions, injuries, damages, or losses resulting from undisclosed conditions, allergies, sensitivities, or failure to follow aftercare recommendations.

I acknowledge and agree

I acknowledge and agree

Signature

Signature