Thank you for selecting Balance Mobile Spa!

Please carefully review the information shown below and if you agree, fill out your information completely and submit your form, so we can get started. Without completing this form in full, we will not be able to move forward with your appointment. We require all clients to fill this form out. Thank you.

Consent and Release Form

This agreement you allow to have a spa treatment or service with our Licensed Massage Therapist, Esthetician and/or Nail Technician. I give permission to receive spa service(s), treatment(s) and/or therapy, which includes massages, facials, body treatments (including body wraps and scrubs), and/or nails. I understand that therapeutic massages, facials, body treatments, or nail services are not a substitute for traditional medical treatment or medications. I understand that my professional licensed massage therapist, esthetician, and/or nail technician does not diagnose illnesses, injuries, or prescribes medications. I have clearance from my physician to receive massage therapy, and/or spa services to the skin, face, back and/or body. I understand the risks associated with massage therapy such as superficial bruising, short term muscle soreness and exacerbation of undiscovered injury. I therefore release the company and the individual massage therapist, esthetician, and/or nail technician from all liability concerning these injuries that may occur during the massage session. I understand the risks associated with applying topical oils, chemicals, lotions and/or heat to my skin during a facial, body treatment, and/or nail service. I therefore release the company and the individual massage therapist, esthetician, and/or nail technician from all liability concerning any skin irritations, infections, redness, future breakouts, rashes, and/or swelling that may occur during a facial, body treatment and/or nail session. I understand the importance of informing my massage therapist, esthetician, and/or nail technician of all medical conditions and medications I am taking, and to let the massage therapist, esthetician, and/or nail technician know about any changes of these. This information will also be on my profile in the notes section. I understand that there may be additional risks based on my physical condition. I understand that it is my responsibility to inform my massage therapist, esthetician, and/or nail technician of any discomfort I may feel during the massage session, facial treatment, body treatment, and/or nail session, so he or she may adjust accordingly. I understand that I or the massage therapist, esthetician, and/or nail technician may terminate the session at any time if the session is inappropriate. I have been given a chance to ask questions about the spa services and my questions have been answered. Draping will be used during the massage session and body treatments - only the area worked on will be uncovered.Please note if your location is more than 25 miles, there is an additional fee of $25 per massage therapist and/or esthetician and/or nail technician per 25 miles traveled. We also have a 48-hour cancellation notice or change date/time/location request, otherwise you could be charged 50% of the total appointment value.

I agree to the terms and conditions listed under the consent and release form.

Please list necessary medical or physical conditions that your massage therapist, esthetician, and/or nail technician should know.

Guest COVID-19 Form

To help stop the spread of COVID-19 and to keep our staff and guests healthy, please answer yes or no to the following COVID-19 questions.

Have you or any member of your household been diagnosed with any contagious inflections including but not limited to COVID-19, strep throat, or the flu WITHIN THE PAST 14 DAYS?

Yes

No

Do you understand that Balance Mobile Spa, LLC cannot be held liable for any exposure to the COVID-19 virus and or any other contagious inflections caused by misinformation on this form or the health history provided by each client?

Yes

No

COVID-19 Release of Liability Waiver

Balance Mobile Spa, LLC is following these enhanced procedures to prevent the spread of COVID-19:

- Prepayment for services available if clients prefer contactless checkout - Additional time included between appointments to prevent guest contact with each other - Guests accompanying those scheduled for services are not permitted - Each guest is required to wash hands upon arrival and before leaving - Your Technician will thoroughly clean hands and wear sterile gloves during all consultations and treatments - Your Technician will wear the following protective gear: mask, and (optional) face guard for each appointment - All skincare product bottles used during treatment will be placed in a separate container for disinfection and disposable items will be used when possible - All surfaces will be wiped thoroughly with hospital grade disinfectant before and after each client according to the manufacturer's directions, and sterilized with a professional steam-sterilization equipment at the end of each day

I agree to each statement above and release Balance Mobile Spa, LLC from any and all liability for the unintentional exposure or harm due to COVID-19.

Sign

Typing your name below, serves as your signature that all of your answer have been truthful to the best of your knowledge.

First Name

Last Name

Date

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

Phone

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Balance Mobile Spa Terms and Conditions / Privacy Policy

Balance Mobile Spa respects your privacy. By opting into our SMS messaging service, you agree to the following terms regarding how we handle your data:

Data Collection: We will collect your name, email address, mailing address, and mobile phone number when you sign up for SMS updates. The information will be collected via the website contact form email, rental agreement, or third-party reservation systems.
Data Usage: We use your data solely for sending updates, promotions, and reminders related to our products or services.
Data Security: We protect your data with secure storage measures to prevent unauthorized access.
Data Retention: We retain your information as long as you are subscribed to our SMS service. You may request deletion at any time.
MESSAGE AND DATA RATES MAY APPLY. Your mobile carrier may charge fees for sending or receiving text messages, especially if you do not have an unlimited texting or data plan.
Messages are recurring, and message frequency varies.
Contact Balance Mobile Spa at 912-323-7795 or info@BalanceMobileSpa.com for HELP or to STOP receiving messages.
Opt-Out: You can opt out of the SMS list at anytime by texting, emailing, or replying STOP or UNSUBSCRIBE to info@BalanceMobileSpa.com or 912-323-7795 . After unsubscribing, you will receive a final SMS to confirm you have unsubscribed and we will remove your number from our list within 24 hours.
You can send HELP for additional assistance, and you will receive a text including our Phone number, email and website. We are here to help you.
Non-Sharing Clause: We do not share your data with third parties for marketing purposes. Balance Mobile Spa will not sell, rent, or share the collected mobile numbers

Customer information is never shared with third parties/affiliates for marketing/promotional purposes. We collect address information for requested shipments and contact information is used to schedule and confirm appointments, etc. All sharing mentioned in this policy excludes mobile opt-in and consent; opt-in information is never shared with anyone for any purpose. Customers can opt out of communications by texting/replying STOP, UNSUBSCRIBE, QUIT; by unsubscribing from the emails. Customers can get more information about our privacy practices or request changes to their information by contacting our office phone number, email, or contact form on the website.

Terms and Conditions

These terms and conditions (“Agreement”) set forth the general terms and conditions of your use of the Balance Mobile Spa website (“Website” or “Service”) and any of its related products and services (collectively, “Services”). This Agreement is legally binding between you (“User”, “you” or “your”) and Balance Mobile Spa (“ Balance Mobile Spa”, “we”, “us” or “our”). If you are entering into this Agreement on behalf of a business or other legal entity, you represent that you have the authority to bind such entity to this Agreement, in which case the terms “User”, “you” or “your” shall refer to such entity. If you do not have such authority, or if you do not agree with the terms of this Agreement, you must not accept this Agreement and may not access and use the Website and Services. By accessing and using the Website and Services, you acknowledge that you have read, understood, and agree to be bound by the terms of this Agreement. You acknowledge that this Agreement is a contract between you and nourish medicine, even though it is electronic and is not physically signed by you, and it governs your use of the Website and Services.

Links to other resources

Although the Website and Services may link to other resources (such as websites, mobile applications, etc.), we are not, directly or indirectly, implying any approval, association, sponsorship, endorsement, or affiliation with any linked resource, unless specifically stated herein. We are not responsible for examining or evaluating, and we do not warrant the offerings of, any businesses or individuals or the content of their resources. We do not assume any responsibility or liability for the actions, products, services, and content of any other third parties. You should carefully review the legal statements and other conditions of use of any resource which you access through a link on the Website. Your linking to any other off-site resources is at your own risk.

Changes and amendments

We reserve the right to modify this Agreement or its terms related to the Website and Services at any time at our discretion. When we do, we will revise the updated date at the bottom of this page. We may also provide notice to you in other ways at our discretion, such as through the contact information you have provided.

An updated version of this Agreement will be effective immediately upon the posting of the revised Agreement unless otherwise specified. Your continued use of the Website and Services after the effective date of the revised Agreement (or such other act specified at that time) will constitute your consent to those changes.

Acceptance of these terms

You acknowledge that you have read this Agreement and agree to all its terms and conditions. By accessing and using the Website and Services you agree to be bound by this Agreement. If you do not agree to abide by the terms of this Agreement, you are not authorized to access or use the Website and Services. This policy has been created with the help of the terms and conditions generator (https://www.websitepolicies.com/terms-and-conditions-generator).

Privacy Policy Statement:

"By registering with Balance Mobile Spa, you agree to the collection and use of your personal information as described in this privacy policy. We will use your information to manage your appointments, provide personalized services, and keep you updated on promotions. You have the right to access and update your information at any time. We will take all reasonable measures to protect your data privacy and will not share your information with third parties without your consent, except where required by law.

Contacting us

If you have any questions, concerns, or complaints regarding this Agreement, we encourage you to contact us using the details below:

info@BalanceMobileSpa.com

This document was last updated on 2/20/2025