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Client Intake Form

Please complete this form to ensure a safe & mindful session. :)

Reason(s) for seeking skin treatments:
Reason(s) for seeking massage:
What kind of pressure do you prefer?
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Cancellation Policy

We understand that life happens, and schedules may need to shift. However, to respect the time of other valued clients, we kindly ask that all cancellations or reschedules be made at least 48 hours in advance of your scheduled appointment. You may do so online in your customer portal.

 

Cancellations made with less than 48 hours’ notice — as well as no-shows — will incur a 25% fee of the scheduled service total.

 

Thank you for your understanding and support of our small business.

Waiver & Release

Welcome! For your safety and the effectiveness of our services, we require all new clients to review and sign the following liability and informed consent agreements. Each section applies to a specific treatment area. By signing, you confirm understanding and acceptance of the terms for each relevant service.

01

Massage Release & Liability Waiver

I understand that massage therapy is provided for the purposes of stress reduction, pain relief, and improved circulation. It is not a substitute for medical care. I have disclosed all relevant medical conditions, injuries, or sensitivities. I acknowledge that some soreness or bruising may result, especially after deep tissue, reflexology, or hot stone massage. I release the spa and its employees from any claims, injuries, or damages that may arise from participation in massage services. I understand that consistent sessions and adherence to aftercare may be necessary for the best therapeutic outcomes.

03

Hair Removal Release & Liability Waiver

I understand that waxing may cause temporary redness, sensitivity, minor swelling, or ingrown hairs. I confirm that I am not currently using retinoids, Accutane, or other skin-sensitizing medications. I acknowledge that it is my responsibility to inform the technician of any skin conditions, allergies, or medications. I agree to follow all aftercare guidelines to reduce the risk of irritation or infection. I release the spa and its employees from any liability for skin lifting, irritation, or allergic reactions related to waxing services.

05

Facial Services Release & Liability Waiver

I understand that facial treatments aim to improve skin health and appearance, but results vary depending on skin type, lifestyle, and consistency. I have disclosed all relevant medical conditions, allergies, and skincare product use. I understand that temporary redness, purging, or sensitivity may occur, especially after extractions or exfoliation. I acknowledge that ongoing treatments and home care may be necessary for optimal results. I release the spa and its staff from liability related to any adverse effects resulting from facial services.

06

Privacy Policy

Privacy Policy

At Moment Aesthetics & Wellness ("we," "our," or "us"), your privacy is important to us. This Privacy Policy explains how we collect, use, disclose, and protect your information when you visit our website or use our services.

Information We Collect

We may collect personal information that you voluntarily provide, including:

  • Name

  • Email address

  • Phone number

  • Appointment requests

  • Consultation information

  • Information you submit through contact forms

  • Information provided during service inquiries

We may also automatically collect certain technical information such as:

  • IP address

  • Browser type

  • Device information

  • Website usage data

  • Cookies and analytics information

How We Use Your Information

We use the information we collect to:

  • Schedule and manage appointments

  • Respond to inquiries

  • Provide requested services

  • Improve our website and customer experience

  • Communicate appointment reminders and updates

  • Send promotional emails or marketing communications (only if you have opted in)

  • Maintain business records and comply with legal obligations

Payment Information

Payments may be processed through secure third-party payment processors. We do not store your complete payment card information on our website.

Cookies & Analytics

Our website may use cookies and similar technologies to improve functionality and analyze website traffic. You may adjust your browser settings to decline cookies; however, some features of the website may not function properly.

Third-Party Services

We may use trusted third-party providers for services including:

  • Online booking

  • Payment processing

  • Email communications

  • Website hosting

  • Analytics

  • Marketing

These providers have their own privacy policies governing the handling of your information.

Sharing of Information

We do not sell or rent your personal information.

We may share information only when necessary to:

  • Provide requested services

  • Comply with applicable laws or legal processes

  • Protect our rights or the safety of others

  • Work with trusted service providers who assist in operating our business

Data Security

We implement reasonable administrative, technical, and physical safeguards to protect your personal information. However, no method of electronic transmission or storage is completely secure, and we cannot guarantee absolute security.

Your Choices

You may request to:

  • Access your personal information

  • Correct inaccurate information

  • Request deletion of your personal information (subject to legal or business recordkeeping requirements)

  • Opt out of marketing communications at any time by using the unsubscribe link in our emails or contacting us directly.

Children's Privacy

Our website is not intended for children under the age of 13. We do not knowingly collect personal information from children.

Links to Other Websites

Our website may contain links to third-party websites. We are not responsible for the privacy practices or content of those websites.

Changes to This Policy

We may update this Privacy Policy periodically. Changes will be posted on this page with an updated effective date.

Contact Us

If you have any questions regarding this Privacy Policy or our privacy practices, please contact us:

Moment Aesthetics & Wellness

6411 Orchard Avenue
Takoma Park, MD 20912

Phone: (240) 203-9116

Email: info@momentaestheticsandwellness.com

02

Chemical Peel Release & Liability Waiver

I acknowledge that chemical peels are advanced skin resurfacing treatments that may cause peeling, redness, dryness, or sensitivity. I confirm I have disclosed any allergies, current medications (including retinoids), and skin conditions. I understand that sun exposure, improper home care, or failure to follow aftercare instructions may lead to adverse reactions. I accept the possibility of temporary skin discoloration or irritation. I release the spa and its staff from liability related to chemical peel treatments. Multiple sessions may be required to achieve optimal results.

04

Microneedling Release & Liability Waiver

I understand that microneedling involves controlled micro-injuries to the skin to stimulate collagen and improve texture. Temporary redness, sensitivity, pinpoint bleeding, or swelling may occur. I confirm that I am not currently pregnant, nursing, or taking blood thinners, and that I do not have any active infections or conditions contraindicated for this procedure. I agree to follow all pre- and post-care instructions. I understand that this is not a one-time treatment and that visible improvement often requires a series of sessions. I release the spa from all liability related to this procedure.

06

Media Release & Liability Waiver

I grant permission for the spa to take photographs or videos before, during, or after my treatment for educational, promotional, or marketing purposes. I understand that my name will not be used without consent, and that all media will be stored securely. I release the spa from any claims related to the use of these materials.

© 2026 by Moment Aesthetics & Wellness

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