Indemnity Form | Nouvelle ere beauty

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First name*

Last name*

Email*

Phone*

Birthday*

Month

Day

Year

Any injuries, surgeries or operations (within 2 years)*

Yes

No

If yes, please specify where and how recent*

Pregnant/Breastfeeding*

Yes

No

Chronic medications*

Yes

No

Any Allergies*

Yes

No

If yes, please specify

I have read and understood the terms and conditions

I agree that I partake in all treatments/ floating baskets at my own risk

I confirm that the information provided is accurate to the best of my knowledge

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