Skin Care Intake Form

Date *

Name *

First

Last

Phone Number *

Email *

Emergency Contact + Phone *

Are you local, part-time or visiting? *

Local
Part-time
Visiting

Would you like to receive our bi-monthly newsletter?

Yes, keep me posted on monthly discounts, updates, workshops and retreats!
Not at this time

What's your city, state and zip code?

How did you hear about us? *

If other, please share!

Within the last year, have you been under a Dermatologist or Physicians care? Any surgeries? *

If yes, please describe.

Any current medications, supplements, vitamins, diuretics, slimming tablets, etc. that you take regularly. *

Do you smoke? *

Do you wear contact lenses? *

Do you have metal implants, a pacemaker, or body piercings? *

If yes or other, please be specific.

Are you pregnant? *

Yes
No
Unsure

Are you taking an oral contraceptive? *

What are your skin care goals for today?

Do you have any skin problems pertaining to your face or body? *

If yes or occasionally, please describe.

Have you ever had chemical peels, microdermabrasion, or any resurfacing treatments? *

Do you use Accutane, Retin A, Renova, or any other prescription skin products? *

How much plain water do you consume daily? *

Do you burn easily in moderate sunlight? *

If other, please describe.

Any other preferences worth knowing? We want you to enjoy a next level experience.

I understand that a valid credit card must be on file to complete my reservation. It will not be charged and is only used in accordance with our late cancellation and no-show policy. I can pay with cash, a different card or a gift card at the time of my service. For individual appointments, all late cancellations or appointment changes must be made at least 24 hours in advance. If I cancel within 24 hours or no-show an appointment, my card on file will be charged the full amount. If I am booking a group reservation, the late cancellation policy is 72 hours and the card on file will be charged for the full amount of all services booked. *

I understand that the services provided are for stress reduction, relief from muscular tension, and improvement of perceived skin quality. I acknowledge that these services are not a substitute for medical care, and that the practitioner is not qualified to perform spinal/skeletal adjustments, diagnose, prescribe, or treat physical or mental illness. I agree that this treatment is a strictly elective cosmetic procedure and no medical claims have been expressed or implied. *

I understand the potential risks of skin care treatments include but are not limited to: temporary irritation, tightness, redness, and slight swelling, which usually dissipate within 72 hours depending on skin sensitivity. *

I acknowledge that I may be more susceptible to sunburn, skin damage and hyperpigmentation, and that I should use sunscreen and avoid excessive sun exposure after treatment. *

I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, waxing, and products containing acids for 2-4 weeks following treatment. *

I understand that skin care treatment is entirely therapeutic and non-sexual in nature, and that the practitioner will never touch genitals, breast tissue, or any other areas, which I instruct them to avoid. I understand that both the therapist and I have the right to refuse treatment and end the session at any time. *

If I experience pain or discomfort during a treatment, I will immediately inform the practitioner so they may adjust their skin care application to my comfort level. I will not hold the practitioner or Maggie Valley Wellness responsible for any pain or discomfort I experience during or after the session. *

I affirm that all known medical conditions, allergies and injuries have been noted on my intake form to the best of my knowledge and that I will ensure the practitioner is notified of these medical conditions, as well as any changes thereof. *

I voluntarily agree to assume all foregoing risks and release the practitioner, Maggie Valley Wellness Center, and any interested parties from any liability or claims for any potential injury, loss, damages, and any associated expenses that may occur or arise in connection with my therapy appointment. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of my massage therapist, Maggie Valley Wellness Center, and any interested parties. *

Signature *

First

Last

gail Urso

2023-10-18

Had a great Facial yesterday. Anna is a great estician. I will be back again. Thank you Anna.

Kayla Shuler

2023-10-15

I had a pumpkin peel facial here, and it was so worth it. So relaxing and refreshing. Anna cleaveland was super friendly and welcoming, I'll be back. Beautiful location, too, btw.

Kara C

2023-10-04

I was given a gift card for services here. I went for a 30-minute upper body massage. It was with Paige and was wonderful! The atmosphere is relaxing, and she asks about sensitivity to oils. Will definitely return!

Tino Metzger

2023-09-28

Atmosphere was nice, place is clean and most importantly, they offer deep tissue massages and other services. I had the deep tissue and felt great when I left

Donna Foster

2023-09-28

My massage was WONDERFUL! I will DEFINITELY be back

ken

2023-09-28

We usually try to get massages while on vacation. It was easy to schedule a couples massage at Maggie Valley Wellness Center. My wife said Danielle was one of the best masseuse's she has had. Mine was also excellent. Will go again if we visit Maggie Valley in the future.

Kelly Marie

2023-09-26

Anna did a fabulous job on my facial ~ she made me feel wholesome and pampered in every way! I highly recommend this wellness center, all of the staff were helpful, knowledgable, and had great vibes! Everyone deserves to experience the wonderful feeling from their wellness professionals.

Melanie Watkins-Patel

2023-09-23

Had the best 90 massage today with Erin! I was so relaxed when I left I could barely walk to the car 😁 Came home and took a long nap, feeling amazing! Thanks Erin!

april WS

2023-09-09

Facial was nice and relaxing

Tammy Garro

2023-08-28

My friend and I went for relaxation massages at Maggie Valley Wellness Center. We both had a wonderful massage and the staff was very kind. Highly recommend!

Call Us

+1-828-944-0288

Email Us

info@maggievalleywellness.com

Our Location

461 Moody Farm Rd, Maggie Valley, NC 28751