Facial Intake Form
It is my choice to receive Urban Sweat Therapeutic, Inc. services. I have completed this form to the best of my knowledge. I have stated all medical conditions that I am aware of and will update Raffa of any changes to my health status. I understand that aestheticians and massage therapists do not diagnose illness, disease, physical or mental disorders, nor do they prescribe medical treatments, pharmaceuticals, or perform spinal manipulations. I acknowledge that these treatments are not a substitute for medical examination or diagnosis, and that is recommended I see a primary health care provider for that service. If I am unable to make a scheduled appointment, I agree to cancel the appointment 24 hours in advance by phone unless I have an emergency. In this case I will call ASAP to reschedule my appointment. If I miss a scheduled appointment without giving 24-hour notice, I agree to pay the missed appointment fee that applies. I understand that any illicit or sexually suggestive behavior, remarks or advances made by me will result in the immediate termination of the session and I will be liable for the payment of the scheduled service.
Please complete the information below.