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Required TDLR In-Take Forms

The goal of all services provided at Aloe is to improve health and wellness of both skin and body. Reactions to treatments done at Aloe are rare and minimal. I agree that if I am unsure of any underlying health condition, I will consult a physician prior to any treatment. I hereby release Aloe and any esthetician and/or massage therapist working at Aloe from all claims, demands and/or damages.

CLIENTS UNDER THE AGE OF 18 must be accompanied by a parent or legal guardian and remain in the building during the entire session. Informed written consent must be provided by a parent or legal guardian.

Massage In-Take Form

Have you had massage therapy before?
Are you pregnant?
Are you breast feeding?
Do you have a history of any of the following?
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Complimentary Aromatheapy?
tdlr massasge form
facial in-take

Facial In-Take Form

Are you pregnant?
Are you breast feeding?
Are you on birth control?
Are you taking hormones?
Do you have any diagnosed skin disorders?
Are you claustrophobic?
Are you using any topical prescriptions?
How would you describe your skin? Check all that apply.
Do you experience any of the following?

Thanks for submitting!

wxing in-take

Waxing In-Take Form

Have you taken accutane within the last year?
Do you frequent tanning beds?
Are you using Retin-A, Differin, or Renova?
Are you taking any medications that make you photosensitive?
Are you currently sunburned?
Are you diabetic?

If you are taking any of the following medications you cannot be waxed today:

ACCUTANE, ADAPALENE, ISOTRETINOIN, RETIN-A, RENOVA, ALUSTRA, AVITA, TAZAROTENE, TRETINOIN, AVAGE, or DIFFERIN.

Do you currently have or have you had any of the following medications that could compromise your skin and/or services being offered?

You may experience skin sensitivity/thinning, which can result in skin lifting from the following: SUNBURN, RETINOL, CERTAIN MEDICAL CONDITIONS, PREGNANCY, ANTIBIOTICS, MENSTRUATION, OTHER MEDICAL CONDITIONS NOT LISTED.

I understand the risks and dangers of waxing and agree to release Aloe Wimberley of all liability in relation to the service being provided. I agree if I begin to use, or are currently using, any of the products listed in the above warning and do not inform Aloe or my esthetician prior to current or future treatments, that I accept full responsibility for any adverse reactions. 

**it is understood that waxing may cause some redness, bumps, soreness, and/or itching**

**if you have recently been vaccinated for COVID19 you may experience a reaction**

Thanks for submitting!

Cupping In-Take Form

Please review the image of possible cupping markings. This image depicts versions of markings that are more extreme than we typically see, however all of these types of markings are a possibility. Sometimes no markings occur, however if they do they can last from a couple of hours to a couple of weeks depending on the individual.
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  • I understand that all treatments at Aloe Wimberley are therapeutic in nature. I agree to communicate to the therapist any physical discomfort or draping issues during the session.

  • Information has been provided to me about Cupping Therapy. If I chose to experience these therapies during treatment, I understand the potential effects and after-care recommendations.

  • It has been explained to me that there are contraindications for Cupping Therapy. I have fully disclosed all health factors to my therapist, including those not mentioned on my health history intake form, to avoid any complications.

  • It has been explained to me that there is the possibility of discolorations that can occur from the release and clearing of stagnation and waste materials from my body.

  • I also understand that this reaction is not bruising, but due to cellular debris, pathogenic factors, and waste material being drawn to the surface to be cleared away by my circulatory system.

  • I further understand that the discolorations will dissipate from a few hours to as long as 2 weeks in some cases, and in relation to my after-care activities.

  • I understand that the first time I experience Cupping, my body’s immune system can temporarily react to this release as it might with the flu - producing flu-like effects such as nausea, headache, aches, etc., that will subside in time with rest and water. Water helps to dilute the intensity of the release.

  • I also understand that emotional releases may occur following Cupping Therapy.

  • I understand that Cupping Therapy modalities should not be combined with aggressive exfoliation, 4 hours after shaving or waxing, after sunburn, or when I’m hungry or thirsty.

  • I understand that I should avoid exposure to cold, wet, and/or windy weather conditions, hot showers, baths, saunans, hot tubs, and aggressive exercise for 4-6 hours. I understand that exposure to such extremes can produce undesirable effects and I should avoid such situations.

  • I understand that I should avoid caffeine, alcohol, sugary foods and drinks, dairy and processed meats, and that I should consume an abundance of clean water.

Thanks for submitting!

cupping in-take form
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