Name *

First Name

Last Name

Becky's Skincare and Bodywork Polices and Consent Form *

Please take a moment to carefully read the following information and check the box below as an online signature to agree with all of the below statements. If you have a specific medical condition or specific symptoms, services including but not limited to, massage, bodywork, skincare, reiki, yoga, meditation, tinting, lash lifts or any other services provided by Becky Payne and Becky's Skincare and Bodywork may be contraindicated. I understand that there shall be no liability on Becky Payne or Becky's Skincare and Bodywork's part if I partake in any services that is contraindicated for me.

Agree

Disagree

Liability *

I understand that all services at Becky's Skincare and Bodywork including, but not limited to, massage, bodywork, reiki, skincare, yoga, mediation, tinting, lash lifts or any other service I receive are provided for the basic purpose of relaxation and that no results are guaranteed. If I experience any pain or discomfort during this session, I will immediately inform the practitioner so that the products, pressure and/or strokes may be adjusted to my level of comfort. I further understand that any services, including, but not limited to, massage, bodywork, skincare, reiki. yoga, tinting, lash lifts or any other service I receive should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, counselors, chiropractor, or other qualified medical specialist for any mental or physical ailment of which I am aware. I understand that during massage, bodywork, skincare, reiki, yoga, tinting, lash lifts or any other service I receive, Becky Payne and Becky's Skincare and Bodywork is not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such. Because massage, bodywork, skincare, reiki, yoga, tinting, lash lifts and any other services should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and allergies. I agree to keep the practitioner updated as to any changes in my medical profile and understand that there shall be no liability on the Becky Payne or Becky's Skincare and Bodywork's part should I fail to do so.

Agree

Disagree

Inappropriate Behavior *

I understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session, and I will be liable for the full payment of the scheduled appointment.

Agree

Disagree

Cancellation Policy for Appointments *

Cancellation Policy for appointments: I understand that a 24 hour advance notice is required when canceling an appointment. This allows the opportunity for someone else to schedule an appointment. If you are unable to give me 24 hours advance notice you will be charged the full amount of your scheduled appointment.

Agree

Disagree

Cancellation Policy for Classes & Workshops *

Cancellation Policy for Yoga, Reiki or Meditation Workshops: I understand that all workshops are non-refundable.

Agree

Disagree

Cancellation Policy for No-Shows *

No-Shows: I understand that no-shows, anyone who either forgets or consciously chooses to forgo their appointment for whatever reason will be considered a “no-show.” You will be charged for their “missed” appointment.

Agree

Disagree

Late Arrivals *

Late Arrivals: I understand If you arrive late, your session may be shortened in order to accommodate others whose appointments follow yours. Depending upon how late you arrive, your therapist will then determine if there is enough time remaining to start a treatment. Regardless of the length of the treatment actually given, you will be responsible for the “full” session. Out of respect and consideration to your therapist and other customers, please plan accordingly and be on time.

Agree

Disagree

COVID-19 *

COVID-19: Please read the following questions. If you have any of these symptoms or circumstances you must cancel or reschedule your appointment or class. You must cancel or reschedule if you have: -Been diagnosed with COVID-19 and have not been cleared by your doctor. -Had a fever of 100 degrees or above in the last 24 hours. -Had any recent respiratory or flu symptoms, cough, shortness of breath or sore throat. -Had any recent chills, new loss of taste or smell or rashes. -Been in contact with anyone within 14 days who has been diagnosed with or shown symptoms of COVID-19.

Agree

Disagree

COVID-19 *

You must also agree to the following: -I agree to wait in my car until my scheduled appointment. I will text Becky at 207-807-1077 to let her know I am here. I will wait until she tells me to come into the office so that she has adequate time to sanitize and so that I will not be in contact with any other clients/students in the waiting room. -I agree to wear a mask into the studio. -I agree to wear a mask during my session. -I will only remove my mask when necessary to perform certain treatments. -I agree to have my temperature taken by Becky Payne and Becky's Skincare and Bodywork before entering into the studio. -I agree to properly wash and then sanitize my hands before my session begins and after the session is complete.

Agree

Disagree

Digital Signature *

By clicking "Agree", I am digitally signing Becky's Skincare & Bodywork's Policies and Consent form and I agree to follow all policies and procedures.

Agree

Disagree