Client Profile Waiver of Liability The Healing House Wellness Spa Services & Educational Workshops

Thank you for completing our client profile. This profile will assist us in identifying relevant medical or lifestyle information that may affect the service you have scheduled with us today and for your future visits. In any event, we will do our best to customize your treatments to your needs.
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Email *
Full Name *
Phone *
Type *
Address *
Date of Birth *
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Occupation *
Work phone
Emergency contact name *
Emergency contact phone number *
How did you hear about The Healing House *
Please list anything you may be allergic to: *
If you have no known allergies please enter "none"
Are you pregnant or think you may be pregnant? *
If yes, how many months
Are you claustrophobic? *
Do you have diabetes? *
Would you like to receive promotional emails from The Healing House? *
Informed Consent for The Healing House Wellness Spa Services
I understand that any services I have scheduled with The Healing House may carry a risk of injury. I recognize that as a result of these services, unpredictable side effects may occur, including, but not limited to, redness of the skin, inflammation, feelings of light headedness, irritation of the skin, blood pressure changes, and allergic reactions.

I understand that a medical evaluation is advisable before commencing any The Healing House Wellness Spa service. I will continue to keep The Healing House Wellness Spa informed of any medical problems or change in my physical condition which may affect services that I have scheduled at The Healing House (of New Mexico). I acknowledge that neither The Healing House, nor its employees, independent contractors and/or health professionals are engaged in diagnosing or treating medical diseases or conditions for these wellness services.

I expressly assume all risks to me associated with any service offered by The Healing House Wellness Spa, and waive any claim which I might otherwise bring against The Healing House Wellness Spa, its officers, directors, shareholders, employees, or contractors as a result of injuries resulting from or relating to my participation in one or more services.

The Healing House Wellness Spa shall not be responsible or liable for any article lost, stolen, or damaged in or about The Healing House Wellness Spa. The Healing House Wellness Spa will not tolerate any inappropriate acts and appropriate dress code is strictly enforced.  Children are responsibility of parent/guardian and should be attended to at all times. I understand that my session can and will be terminated due to any form of inappropriate behavior. We are committed to professionalism and expect the same from our clients.

Client Signature *
By typing my full name and contact email address, I confirm that I agree to the electronic submission of my completed Waiver of Liability and that I accept that the information provided constitutes a legally binding digital signature.
Date *
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