Body Polish and Wrap Consultation and Consent Form

Client Details

Full Name: *

Date of Birth: *

Email: *

Contact Number: *

Medical History

Are you currently taking any medication? *

Please list: *

Do you have any allergies or intolerances? *

Please list: *

Are you currently (or possibly may be) pregnant? *

Do any of the following apply to you? Please tick all that apply.

Do you have any other medical conditions? *

Please list: *

Are there any areas of the body your therapist should avoid? *

Please specify: *

Have you recently been unwell? *

Which of the following were you unwell with? *

Please provide more detail: *

Emergency Contact Details

Emergency Contact Name: *

Emergency Contact Relationship: *

Emergency Contact Phone: *

Treatment Information

What is a body wrap?

A body wrap is a nourishing cocoon designed to slim and tone your body, hydrate, cleanse or heal your skin, or relax and soothe your muscles.

Beauty benefits of a body wrap

Body wraps combine therapeutic masks — herbal pastes, mineral-rich muds or soothing creams — with thermal coverings. The body mask will contain a mixture of ingredients designed to have a remedial effect on your skin, while the coverings will swathe and warm your body, promoting muscle relaxation, and sweating to cleanse your pores.

There are different body wrap treatments available: slimming, detoxifying, relaxing and hydrating.

Depending on the wrap you choose, you might notice:

temporary inch loss
softer, firmer, hydrated or cleansed skin
reduced appearance of cellulite
relaxed muscles

Weight-loss wraps do not make you lose weight, but they may make you temporarily slimmer. Although any initial inch loss will sadly disappear once you drink some water, the wrap experience might just provide the motivation you need to start a healthier diet or fitness programme.

Some wraps are designed to relieve tired or heavy legs and aching joints, and ease inflammation, and may be offered as a treatment for your lower body only.

What to expect from a wrap

You will be treated with a gentle exfoliation or scrub to slough away any dead skin cells. If the wrap promises inch loss, you'll be measured at various points around your body first, too.

Once your skin has been prepped, your therapist will apply a therapeutic body mask to your torso, and your arms and legs. The content of the mask used depends on the treatment you have chosen.

After applying the mask to most of your body, your therapist will swaddle in a plastic sheet and towels, and leave you to rest for around 20 to 40 minutes.

The heat of the wrap will relax your muscles, open your pores and encourage sweating. So, to keep you comfortable, you might have a cold compress placed gently on your forehead.

When you're freed from your cocoon, don't expect an immediate butterfly-like transformation. You might feel quite cold and soggy at first without your thermal blanket - so the shower afterwards will be welcome. You can scrub away any remaining algae, mud or clay before your therapist massages moisturiser into your newly baby-soft skin.

Possible side effects

Since many of the wraps require a tight wrap of the material around your body, you may have some unpleasant side effects from the compression.
The risk of becoming dehydrated is also likely since body wraps work to increase your internal core temperature. Drink plenty of fluids.

Consent

Please read each statement carefully and tick to show your agreement. *

I accept that any treatment I am going to receive is at my own risk. I certify that I have read and fully understood and completed this form to the best of my knowledge. I understand that failure to disclose information requested above may result in adverse side effect(s) and therefore I accept full liability/responsibility for the information given. The treatment(s) and possible side effect(s) have been fully explained to me. I accept full responsibility for the treatment given and complications which may arise or result during or following any procedure that is performed at my request. I accept that if I am not satisfied with the treatment I will inform the therapist and/or request to speak to the manager during or immediately following the treatment. I fully understand the above and consent to receive a Body Wrap treatment.

Client Signature: *

Tap or click on the signature above to sign