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Head Spa Intake Form

Please fill out the following form to help us understand your physical condition.

CLIENT INFORMATION

Date of Birth
Month
Day
Year

MEDICAL CONDITION / OTHERS

Are you currently pregnant?
Are you okay with aromatherapy essential oils?
Have you had a head spa before?
I understand that I should wait at least 1 week before and after a color or chemical service of any kind to receive a head spa treatment
Do you require any special accommodations for your appointment?
Do you have any allergies or sensitivites?
Do you have any known scalp conditions, skin infections, diseases, viruses, or recent injuries/surgeries?
What are your goals for your head spa session?

Luz Spa Studio - Liability Waiver

If I feel any pain or discomfort during my head spa session, I’ll let my practitioner know right away so they can adjust the pressure. I understand that head spa is not a medical treatment or diagnosis and doesn’t replace a visit to the doctor for any health issues I may have.


I confirm that I answered all health questions honestly. I understand that if I leave out any info, I take full responsibility, not the practitioner or Luz Spa Studio. I agree to keep my health info up to date and know that Luz Spa won’t be held responsible if I fail to do so. I give my full consent to receive care.

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Luz Spa Studio – Appointment Policy


• Cancel or reschedule at least 24h in advance.

• Cancellations under 24h or no-shows = $50 fee.

• Up to 15 min late is okay, but time will be deducted.

• After 15 min = no-show and fee applies.

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Luz Spa Studio – Guidelines


• Please arrive without makeup or jewelry.

• No guests or children allowed during appointments, unless it's a parent/guardian for clients 15 and under.

• All services, gift cards, and product sales are final – no refunds.

• No head spa for clients with extensions, braids, open wounds, or severe scalp conditions.

• Wait at least 1 week before or after any chemical treatment.

• Clients under 18 must have signed consent from a parent/guardian.

• Clients under 16 must be accompanied during the session.

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I hereby grant permission to Luz Spa Studio to use photographs or video of me taken during my head spa session on social media, website, or advertisements.
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