About You – Ravens Reflections

Ravens Reflections | About You

Raven is an esthetician. With her skills she will provide deep cleansing and relaxation that will allow you to get closer to the healthy, balanced appearance you are hoping for. You will leave feeling well cared for and more integrated. Embrace your beauty and truth. Based in Eugene Oregon

Esthetician, Skin Care, Beautiful, Beauty, Luxury, Eugene, Oregon, Raven, Facials, Body Scrub, Chemical Peels, Skin Peels, Acne Treatment, Microderm, Microdermabrasion, Aviles, reflections, pet care, PCA, physicians care alliance, herbal

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Intake Form

If you would like to arrange an appointment with me please fill out my intake form below and I look forward to hearing all about you.

First Name *

Last Name*

Email*

Phone*

Date of Birth

To change the year please click the year number on the popup. Some devices you can swipe.

Address

Apt/Suite

City

State

Zip

How did you find out about us? Who referred you?

What are your skincare objectives?

What do you appreciate about your skin/body?

Do you have any allergies and/or skin sensitivities?

Do you have any particular essential oil scents that you favor and/or dislike?

Would you consider you skin dry, normal, sensitive, combination, oily?

Do you take any medications, supplements? What kinds?

Are you pregnant or nursing?

Have you ever been treated for cancer?

Have you had any surgeries? When?

Is there any illness/condition you are presently being treated for by a medical professional?

Do you wear contacts, dentures, removable bridgework/retainers, hearing aids?

Have you recently received botox, dermafillers? When?

Have you had any hair removal/shaving done in the last week?

Do you bruise easily?

Are you comfortable having your scalp touched/massaged?

Have you experienced any spa treatments? What? When?

If I experience any pain or discomfort during this session, I will immediately inform the practitioner so that the treatment being administered can be adjusted to my level of comfort.

I give permission to my practitioner to perform the procedure we discussed and will hold her harmless from any liability that may result from this treatment. I understand my esthetician will take every precaution to minimize or eliminate negative reactions.

I further understand that all services rendered should not be construed as a substitute for medical care and that I should see a qualified medical specialist for any physical conditions or medical concerns.

I affirm that I have stated all my known medical conditions and answered all the questions honestly. I agree to keep the practitioner updated as to any changes in my medical profile and understand that there shall be no liability on the practitioner's part should I fail to do so.

I also understand that any illicit or sexually suggestive remarks or advances made are unlawful and will result in immediate termination of the session.

By typing your name below you are acknowledging this as your digital signature.*

Date of Signature*

Important Information

Please read and check the following for acknowledgement

Reservations: To insure you obtain the desired appointment time that is most convenient for you, please schedule your appointment as far in advance as possible. To accommodate your appointment, a credit card or gift certificate is required at the time of booking to guarantee your reservation. You will not be charged unless there is a late cancellation or no-show. Upon your check out you may choose a different method of payment for that day's service.

Cancellation policy and fees: Please call as early as possible with a minimum of 24 hours if you must cancel or reschedule your session. Both your time and mine are valuable so please be considerate. Raven's Reflections LLC will charge $25 per hour that was scheduled for your session for late cancellations and no-shows. If you arrive late your session may be shortened to stay on schedule and you will be charged the full time.

Special needs: Please notify Raven's Reflections LLC of any allergies and/or sensitivities to aromas or ingredients(this includes nuts and fruits too) when you schedule your appointment. Raven's Reflections LLC does use many essential oils, therefore the spa space will not ever be fragrance free. Although with enough notice an attempt will be made to neutralize the intensity beforehand and Raven's Reflections LLC is willing to use your personal fragrance free products to complete your service. This must all be agreed upon in advance. There are a couple of flights of stairs to navigate at the current spa location, if you are unable to climb stairs we may be able to find another creative solution.

Parking: Parking on the street is metered 7:00am-6:00pm Mon-Sat. It is $.60 for 30 minutes, $1.20 for 1 hour with a maximum of 2 hours. It is suggested to park at the Parcade parking garage @ 35 W. 8th Ave. The 1 st hour is free and then $1/hour up to $6 for all day parking. It is free on weekends and holidays except for event parking.

Prices and Services are subject to change without notice. Raven's Reflections LLC will do the best to keep you up to date on any changes that may occur and it is encouraged that you inquire about pricing and services at the time of making your reservation.

Raven's Reflections LLC is unable to return or reimburse any payment transaction on spa packages/ series and will exchange them for other products/services of equal value. THANK YOU FOR YOUR UNDERSTANDING.

We accept all major credit cards, but there is a 3% processing fee for all credit card payments. This fee is non-refundable and is applied to all orders placed using a credit card.

I have read the above information and I agree. By typing my name I am acknowledging this is a digital signature:*

Date of Signature*