Body Wrap





Lavender Falls Face & Body Spa LLC

Client Informed Consent Form

Body Wrap







19239 Stone Oak Pkwy, #201

San Antonio, Texas 78258

Phone: 210-446-0903

Online Booking Available

Treatment Consists of:

Body wraps can be hydrating, detoxifying, ant-aging or slimming.

The body is coated with the appropriate mask preparation. Once the product is on, you’re wrapped to stay warm.

When the time is up, you’re unwrapped and the body mask is removed.

Clients Acknowledgements:

* If you have claustrophobia, this may not be the right treatment for you.

You may not want to allow yourself to be wrapped if you: have a heart condition (specifically conditions requiring Coumadin or other blood thinners), epilepsy, or are pregnant or nursing.

Information: I acknowledge I am not currently nor have used any of the products listed below within the time frame listed.

Pre-Treatment Acknowledgement

      Allergies -I am not allergic to any of the ingredients in the treatment.

      Sunburn - 1 week prior to treatment.

      Pregnant or Breastfeeding


*Notify your aesthetician of any medical conditions & medications (Current & within the last 90 days).

Post Treatment Acknowledgement

      You may return to their normal activities immediately after the treatment or as directed by your aesthetician.

Side Effects:

Possible side effects include but are not limited to:

• Heat increases the irritation potential of any product being applied to the body, so clients are at greater risk for developing skin irritation during treatments.

• Uncommon side effects such as an allergic reaction and skin irritation can occur.

There may be risks not yet known at this time.


     I understand that any time the skin barrier is compromised; there is a small risk of infection. I will contact my aesthetician immediately should this happen.

     The Body Wrap treatment has been fully explained and any questions or concerns that I have, have been addressed.

     I acknowledge that no guarantee has been given to me as to the condition of the complexion, skin pore size, wrinkles or the percentage of improvement expected following treatment, due to each individual’s unique reactions.

     I acknowledge this procedure is strictly an elective cosmetic procedure and that no medical claims have been expressed or implied.

     Photographs May be taken for comparison for future treatments for my chart.


I have read the above and understand it. My provider has answered my questions satisfactorily. I accept the possible risks and complications of the treatment.


I acknowledge that Lavender Falls Face and Body Spa has a no-refund policy on any products or service. There will be no refunds for any reason.


All services performed are without any guarantee. By continuing with service, you are confirming that you have read and understand our no refunds policy.








Lavender Falls Face and Body Spa LLC

Thank you for choosing and trusting Lavender Falls Face & Body pa LLC for your aesthetic needs

Feel free to contact us at 210-446-0903 if you have any questions




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Signature Certificate
Document name: Body Wrap
lock iconUnique Document ID: fec8ae492804aa70685f5ab772eb09db90c1a242
Timestamp Audit
April 8, 2017 8:09 pm CSTBody Wrap Uploaded by Lavender Falls Face and Body Spa LLC. - IP