To secure your appointment you will be asked to provide your credit/debit card number to put on a secure file. As therapists we are physically limited in the number of clients we can treat in a day. For that reason at least 24 hour cancellation notice in required to avoid a charge, you might be charged up to full cost for a no show or the very last minute cancellation since the therapist has reserved that time for only you in the schedule and we are unable to replace anyone the last minute. If you give us notice less than 24 hours prior but enough time to potentially rebook another client such as at least 12 hours, in that slot, you may be charged less than 100% or can receive a credit for future bookings. If you no-show and do not notify us it will be 100% charge. If it’s a proven medical emergency such as sudden illness or contagious illness diagnosis you will receive credit for your next appointments. Thank you.
Ways to save on your massage and skin care treatments
- Due to VT Massage Therapy non-existing laws, we can not bill insurance directly except some workers comp or other cases, but can assist you with providing required documentation or a super bill. You can also use your Flex spending cards or other similar Health Savings Account Cards provided by your work place.
- Memberships and Packages: https://jolitabrilliant.com/brilliant-membership/
- Receive A Free Add-On or 10% off On Your Birthday! And save extra 5% on packages (total 15% off)! *
- City Market Co-op members receive an additional 5% off packages a total of 15% savings and no card fee. As well as Free add on for first time BMT clients who are co-op members.
Consent For Massage Services
Booking with Brilliant Massage Therapy, LLC I understand that the massage/bodywork I receive is provided for the basic purpose of relaxation and relief of muscular tension. If I experience any pain or discomfort during this session, I will immediately inform the practitioner so that the pressure and/or strokes may be adjusted to my level of comfort. I further understand that massage or bodywork should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor, or other qualified medical specialist for any mental or physical ailment of which I am aware. I understand that massage/bodywork practitioners are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such. Because massage/ bodywork should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the practitioner updated as to any changes in my medical profile and understand that there shall be no liability on the practitioner’s part should I fail to do so. I also understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session, and I will be liable for payment of the scheduled appointment.
Consent For Esthetics Services
Booking an appointment at Brilliant Massage Therapy, LLC I agree to provide full disclosure and inform the esthetician if I experience any skin discomfort during a treatment, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation to the esthetician may result in contraindications and/or irritation to the skin from treatments received. The treatments I receive here are voluntary and I release this institution and/or skin care professional from liability and assume full responsibility thereof. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product / post-treatment care, I will consult the esthetician immediately. I have had sufficient opportunity for discussion to have any questions answered.
Please note that peels and certain face products can cause peeling or temporary irritation, discomfort to certain individuals and is expected. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.
Please note that waxing does have certain side effects such as skin removal, redness, swelling, tenderness, etc.
LAMPROBE INFORMED CONSENT FORM
Skin Care Consultants has explained to me the Lamprobe processes are popular and effective for the cosmetic treatment of unwanted hair follicles and certain minor superficial skin irregularities that professional skin care practitioners encounter on a daily basis.
I consent to have the Lamprobe performed or demonstrated on me and further consent to have the Practitioner elect one of the following skin irregularity or irregularities to be treated:
Risks associated with the Lamprobe may include, but are not limited to, burns/scabbing, blistering, skin discoloration, infection, and scarring. I understand that it is strongly advised and imperative that persons receiving cosmetic treatments using Lamprobe processes closely follow the Home Care Advice described below and further understand that failure to follow the below-described Home Care Advice may result in infection and scarring.
By consenting to having the cosmetic treatments using Lamprobe performed or demonstrated on me, I hereby release and forever discharge the performing practitioner of said cosmetic treatment, Skin Care Consultants, its officers, employees, and/or associated sub-contractors, manufacturers, distributors and suppliers from all claims, demands, causes of action arising out of the performance of the said cosmetic treatment procedures excluding any claims for gross negligence or willful misconduct. __________
Lamprobe regularly documents the demonstration and use of the Lamprobe, using before/after photos and/or videos. I understand that this documentation will be the property of Lamprobe and may be used at a later date for educational and/or marketing purposes and I consent to this use. __________
Home Care Advice:
After treatment with the Lamprobe, the areas cosmetically treated may feel irritated and redness and scabbing may form.
1. Do not directly touch treated area for 24-48 hours following treatment, as this can increase the risk of infection.
2.Do not pick at the scabs, as premature removal of scabs may result in hyper-pigmentation, infection, or scarring.
3. If the cosmetically treated area is still irritated in the evening, then apply antibiotic cream, e.g., Neosporin, or medicated powder to the area. Keep the area dry for 24-48 hours following treatment.
4. While cleansing the face or showering, use mild products without alcohol. When appropriate, band aids should be applied to the treated area for further protection while showering or bathing.
5. After washing, pat the treated area dry. Do not rub the treat area as rubbing may result in the removal of the scab.
6. Do not apply make-up on the cosmetically treated area for 24 hours following treatment or until skin is healed.
7. Do not use any other form of peeling or bleaching products for at least 21 days following treatment.
8. Use of sun protection during the day, all year round, is recommended. Avoid direct sunlight during the peak hours (11am-5pm).
Teeth Whitening Consent Form:
P.S. All bills must be paid in full once the service is rendered or products are ordered for you. We not not offer pay later options. Thank you.
Service costs and products are subject to price changes without advance notices and adjusted every year due inflation, based on demand and supply and to be able to continue to provide services at the same quality and convenience. If change of price does not meet your expectation you have the right to cancel the service.