Welcome to MRVL Spa. This consultation form will allow your therapist to collect the relevant information to design a safe and personalized experience during your visit at the spa. All information given to us is strictly confidential.
Full Name:
Date of Birth: (MM/DD/YYYY)
Email Address:*
Emergency Contact:*
Medical History
We adhere to the highest standard of care and appreciate being informed of any possible contraindications:
Heart conditions
Diabetes
Blood disorder
Stroke
Cancer
Low-High BP
Pacemaker / Metal implants
Asthma
Arthritis / Autoimmune conditions
Back problems
Digestive issues
Fillings / Cavities
Eczema / Psoriasis
Keloid scars
Edema / Thrombosis
Varicose Veins
Herpes / Cold sores
Headaches / Migraines
Seizures / Epilepsy
Insomnia
Claustrophobia
Allergies / sensitivities
Other
None
Other:
Additional Details
Have you been under the care of a dermatologist within the past year?*
Yes
No
If yes please provide details:
Are you taking any medications or dietary supplements?*
Yes
No
If yes please provide details:
Have you had any surgery in the last 12 months?*
Yes
No
If yes please provide details:
Have you received Botox, Restylane, Collagen or any other injections in the last 6 months?*
Yes
No
If yes please provide details:
Do you wear contact lenses?*
Yes
No
If yes please provide details:
Is there anything that may be important for us to know?
For ladies: Are you pregnant, planning a pregnancy, breastfeeding, using birth control or
menstruating?
Yes
No
For ladies: Are you taking birth control pills?
Yes
No
Body Concerns:
Muscular Tension
Fluid retention
Stress
Dry Skin
Cellulite
Energy levels
Poor Circulation
Aches / Pains
Overweight
Varicose veins
Other (please specify)
Other?
What is your current facial care routine?
Facial concerns:
Aging
Dull Skin
Oily Skin/ Excess Shine
Blackheads/Whiteheads
Breakouts / Acne
Dehydration
Broken Capillaries
Redness
Wrinkles/Fine Lines
Flakiness
Pigmentation
Sensitivity
Uneven skin tone
Ingrown hair
Shaving rash
Other (please specify)
Other?
What is your current body care routine?
Liability Waiver
I 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
Name :*
Signature*
Click to sign
Please Enter Date (MM/DD/YYYY)
MRVL Spa Policy
Cancellation 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 Policy
Massage 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 Policy
At 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.
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