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Redandwhitespa.com

FACIAL GUEST CARE FORM
PROMISE TO YOU
If you’re not happy with our service for any reason we will reschedule a second visit at no charge or issue a full refund along with our sincerest apologies! PERSONAL INFO
Client Name: ______________________________Therapist: _______________________________
Client Address: _____________________________City:________________ State:_____Zip: ______ Cell Phone: ________________________________E-mail:_________________________________ Birthday: Month_____________ Day______ Anniversary: Month___________ Day_______
MEDICAL HISTORY
Do you have any health concerns your therapist should know about?____________________________ Are you pregnant?_________________________________________________________________ Do you have any allergies or sensitivities to products?_______________________________________ Do you have any special concerns pertaining to your face or body? S Yes S No If yes please specify? ______________________________________________________________________________ Have you ever had chemical peels, microdermabrasion, or any resurfacing treatments? S Yes S No Do you use Acutane, Retin A, Renova, Adapalene or any other prescription skin products? S Yes S No Are you currently using any products that contain the following ingredients?S glycolic acid S lactic acid S any hydroxy acid product S vitamin A derivatives (i.e. retinol) S any exfoliating scrubs Do you consider your skin to be sensitive? S Very S Somewhat S Not usual y It’s always a good idea to use the restroom before the service!
FACIAL POLICY
Please be advised that a one hour facial session includes: 5 minute initial set up client comfort time, 50 minute actual facial time and 5 minute after session client comfort zone. I hereby consent to the above–mentioned treatment and assume all risk of personal injuries. I voluntarily release Red & White Spa from any and all liability claims, or actions which may be related to any treatments received.
IMPORTANT
Please ask the Aesthetician within 10 minutes of the start of the facial to STOP if you are not happy with
the service. At that point we will gladly reschedule a second visit or issue a full refund with our sincerest
apologies. However, after 10 minutes we will NOT be able to reschedule or offer a refund.
Initial:_____________
Client Signature: _____________________________ Date: _____________________________ SPA USE ONLY
Comments / Remarks____________________________________________________________________________
_______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Service Provider Name__________________________________

Source: http://www.redandwhitespa.com/forms/Facial_Guest_Care_Form.pdf

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MEDPHARM NON FDA PRODUCT LIST (EUROPEAN ORIGIN) THERAPEUTIC CAT PROD CODE GENERIC DESCRIPTION QUANTITY ANALGESICS, ANTIPYRETICS, ANTI-INFLAMMATORY, ANTIRHEUMATIC DRUGANTIALLERGICS AND DRUGS USED IN ANAPHYLAXISepinephrine (adrenaline) 1 mg/ml 1 ml (two end)ANTIALLERGICS AND DRUGS USED IN ANAPHYLAXISalbendazole 400 mg chewable peppermint flavouredalbendazole 400 mg chewable pe

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DRAFT SCHEDULE** (Times and Speakers Subject to Change) Marriott World Center SCHEDULE-AT-A-GLANCE THURSDAY, May 17, 2012 PRE-CONFERENCE WORKSHOPS: REGISTRATION OPENS 9:00 am – 6:00 pm Putting it all Together: The Nuts and Bolts of Sangeeta Pati, MD Hormone Restoration in Men and Women 9:00 am – 5:00 pm Transforming Theoretical Into Practical: A Lena Ed

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