New Client Form

Please complete this form before your first treatment. 

Name *
Name
CC#, EXP., ZIP CODE
Please read through the consent form below and electronically sign in the space below
Kristina Holey is an integrated, informative, educative, and licensed aesthetician with the mission of providing self-healing tools to people for restoration of health and prevention of imbalances pertaining to the skin. The philosophy in which Kristina Holey bases her practice on has not been evaluated by the Food and Drug Administration or any medical association. Any of the products used in treatment have been carefully researched and approved for appropriate usage on the skin, as directed. None of the information or products Kristina Holey suggests or uses are intended to diagnose, treat, cure or prevent any disease. For medical concerns, please consult your physician. Before making changes to your diet or lifestyle, please consult your physician. Please DO NOT take the protocol* from Kristina Holey to substitute your medical treatment. The Kristina Holey approach is a long term, slow acting preventive therapy that includes diet, lifestyle changes along with facial massages, and topical and internal suggestions. IT IS NOT A MEDICAL PLAN. It is the therapy that slowly introduces healthy habits for improvement of health and helps in preventing risk of imbalance within the skin. It is NOT AN ALTERNATIVE PLAN for medical treatment. *Please inform your physician about your new protocol before you incorporate changes to your diet and lifestyle. Kristina Holey does not intend to diagnose, treat, cure or prevent any disease. Kristina Holey Studio is NOT a medical facility or provides emergency services. Please call your physician, medical facility or emergency services for ALL medical complaints.
Please read carefully and only electronically sign below if you are in full agreement with its contents. *
Please read carefully and only electronically sign below if you are in full agreement with its contents.
I ---------------------------- confirm that I have understood the treatment that I am to receive and confirm that I am willing to proceed without confirmation from my own GP or Consultant. I understand that some products used for skincare may be inappropriate for usage during pregnancy and it is my responsibility to inform Kristina Holey if I should fall pregnant while under her care. I will also inform Kristina Holey of any allergies or restrictions so that the treatment may be tailored to my needs. I do not expect Kristina Holey to anticipate any reactions topically from product usage. I wish to rely on Kristina Holey to exercise judgement during the course of the treatment and trust those to be in my best interest.
Date
Date
Check below to agree with the above terms. *