Pure Spa Wellness Center

​

May NOT be done if you have any of the following:  

  

• Presence of infection:   

edema, puss  

  

• Moist desquamation:   

skin peeling with the presence of infection  

  

• Pain:  

sensitive to touch  

  

• Chemo-induced acne:   

acne lesions produced by systemic chemotherapy  

  

• Open wounds:   

wounds that are not healing, susceptible to infection  

  

• Hyper sensitivity:   

extremely sensitive skin, contact dermatitis  

  

• Rash:   

vesicles, inflammation, pruritus  

  

  

These guidelines are in place for your protection and ours, as I strive to serve you to the best of my ability. Please contact our me directly if you have any questions or need additional information. Your answers to the questions on this form are essential for a safe, effective session. Please take some time to answer in detail, and have this paperwork completed prior to the start of your appointment.