Date of Birth: (MM/DD/YYYY)
Medical HistoryWe adhere to the highest standard of care and appreciate being informed of any possible contraindications:Heart conditionsDiabetesBlood disorderStrokeCancerLow-High BPPacemaker / Metal implantsAsthmaArthritis / Autoimmune conditionsBack problemsDigestive issuesFillings / CavitiesEczema / PsoriasisKeloid scarsEdema / ThrombosisVaricose VeinsHerpes / Cold soresHeadaches / MigrainesSeizures / EpilepsyInsomniaClaustrophobiaAllergies / sensitivitiesOtherNone
Have you been under the care of a dermatologist within the past year?*YesNo
If yes please provide details:
Are you taking any medications or dietary supplements?*YesNo
Have you had any surgery in the last 12 months?*YesNo
Have you received Botox, Restylane, Collagen or any other injections in the last 6 months?*YesNo
Do you wear contact lenses?*YesNo
Is there anything that may be important for us to know?
For ladies: Are you pregnant, planning a pregnancy, breastfeeding, using birth control or
For ladies: Are you taking birth control pills?YesNo
Body Concerns:Muscular TensionFluid retentionStressDry SkinCelluliteEnergy levelsPoor CirculationAches / PainsOverweightVaricose veinsOther (please specify)
What is your current facial care routine?
Facial concerns:AgingDull SkinOily Skin/ Excess ShineBlackheads/WhiteheadsBreakouts / AcneDehydrationBroken CapillariesRednessWrinkles/Fine LinesFlakinessPigmentationSensitivityUneven skin toneIngrown hairShaving rashOther (please specify)
What is your current body care routine?
Liability WaiverI have read the above information and have given an accurate account of the questions. If I have any concerns, I will address these with my therapist before the service and inform them of any changes in the above information. I have been informed of and understand the contraindications to the requested treatments and agree that I do not have any condition(s) that would make the requested treatment unsuitable. I will inform the technician of any discomfort I may experience at any time during my treatment to allow them to adjust accordingly. I understand that the services offered are not a substitute for medical care and any information provided by the therapist is for educational purposes only and not diagnostically prescriptive in nature. I give permission to my therapist to perform the service and will not hold the therapist nor MRVL Spa accountable for any liability that may result from this treatment. I understand that the information herein is to aid the therapist in giving better service and is completely confidential.
I HAVE READ AND UNDERSTOOD THE TERMS AND CONDITIONS
Please Enter Date (MM/DD/YYYY)
MRVL Spa Policy
We respectfully ask that you provide us with a 24-hour notice of any schedule changes or cancellation requests. Please understand that when you cancel or miss your appointment without providing a 24 hour notice we are often unable to fill that appointment time. This is an inconvenience to your therapist and also means our other clients miss the chance to receive services they need. For this reason, you will be charged 50% of the service fee for the first missed session and 100% of the service fee for each session after that. We also reserve the right to
require a credit card number to be given to book future appointments so that appropriate fees may be charged if a late cancellation does occur. We understand that emergencies can arise and illnesses do occur at inopportune times. If you have a fever, a known infection, or have experienced vomiting or diarrhea within 24 hours prior to your appointment time, we request that you cancel your session. Inclement weather may also result in the need for late cancellations. We will do our best to give advance notice if we are closing or need to cancel due to bad weather and we ask you to do the same. Please do not risk your own safety trying to make your appointment. Late cancellation due to emergency, illness, or inclement weather will generally not result in any missed session charges, but this is determined on a case-by-case basis.Inappropriate Behavior PolicyMassage therapy is for relaxation and therapeutic purposes only. There is absolutely no sexual component to massage whatsoever. Any insinuation, joke, gesture, conversation, or request otherwise will result in immediate termination of your session and a refusal of any and all services in the future. You will be charged the full service fee regardless of the length of your session. Depending on the behavior exhibited we may also file a report with the local authorities if necessary. Treat your therapist with respect and dignity and you will be treated the same in return. By agreeing to Terms and Conditions, you agree to abide by these policies.Data Protection PolicyAt MRVL Spa we process your personal data with respect to your privacy and data protection rights. We only collect and process the personal information that is necessary for the selected treatments and rely on your explicit consent for data processing. We do not share the personal data you provide us during your visits to our facilities with any third parties, for the purposes irrelevant to your contract, we may share your information within our group - companies and public services for the above described purposes. We store your health data on our system and make sure that all safety and security measures are taken during the provision of our services.