Acknowledgment Form:

Client Information:

Name

Email

Phone

City

Service Details:

Date and time of appointment

:

Is this service for:

Man

Woman

Other

Which category best describes your hair length?

Please note: For long hair or locs, book at least a 90-minute package; for dreadlocks, book 120 minutes. Contact us to change your package if your hair requires more care.

Our Hydration Head Spa includes services like a mini facial and mask, but our primary focus is on your hair. If the selected package is too short, we may need to skip steps or add extra time.

Client Declaration:

I declare that I do not have any scalp or hair issues that could be contagious to staff members or other clients, such as:

Lice
Ringworm (Tinea capitis)
Impetigo
Folliculitis

I understand that Bella Gaia focuses on relaxation and regular hair treatments to help my hair look and feel great, stay healthy, and grow beautifully. Bella Gaia does not handle any contagious hair or skin conditions.

I also declare that I do not have any other contagious health issues that could affect others.

Health & Sensitivity Information:

Do you have any specific concerns regarding your hair or scalp health?

Yes

No

If yes, please specify:

Do you have any allergies?

Yes

No

If yes, please specify:

Do you have any skin conditions or sensitivities?

Yes

No

If yes, please specify:

Are you allergic or sensitive to any beauty products?

Yes

No

If yes, please specify:

Please let us know if you are injured or pregnant or need special care:

Service Acknowledgment and Consent:

I understand that the Hydration Head Spa service includes various techniques and products aimed at promoting scalp health, improving circulation, and enhancing relaxation. These may involve:

Scalp massage
Application of oils, creams, or other scalp treatments
Hair steam therapy
Use of specialized tools for scalp stimulation
Facial steam, creams, exfoliation, and oils
Rubbing of hands, arms, legs, feet, and neck

I acknowledge that while the Hydration Head Spa service is generally safe, there may be risks involved, including but not limited to:

Skin irritation or allergic reactions to products
Discomfort or pain during the treatment
Rare incidences of adverse reactions to massage or stimulation techniques

Clothing Preferences:

For women, we provide a clean, comfortable, open-shoulder dress or a two-piece set with shorts and a top (one-size-fits-up-to-3XL) to prevent your clothes from getting wet. Would you prefer to wear your own loose and accessible clothing?

Use what Bella Gaia provides

Wear my own clothing

For men, we provide a clean short, throw-over robe (one-size-fits-up-to-4XL). We do not have a top for men. Would you prefer to wear your own loose and accessible clothing or use what we provide?

Use what Bella Gaia provides

Wear my own closing

Product Preferences:

Would you prefer to use our products or bring your own?

Use Bella Gaia’s products

Bring my own products

If bringing your own products, please specify which products you will bring:

Special Occasion:

Are you here to celebrate a special occasion?

Yes

No

If yes, please specify and add your personal message or request:

Media Consent:

I allow Bella Gaia to take headshot photos or videos of my Hydration Head Spa session for training and social media (FB, IG, TikTok). No sensitive images will be shown. Bella Gaia will show me the images for my final verbal approval before public use

Yes

No

Personal Note to Bella Gaia:

We value your feedback and any special requests you may have. Please feel free to leave a personal note for us:

Acknowledgment and Agreement:

I have read and fully understand the contents of this Pre-Online Check-In and Waiver form. I voluntarily agree to the terms and conditions stated above.

Date

Signature

BELLA GAÏA

HYDRATION HEAD SPA

Acknowledgment Form: