978-650-2895 | 978-244-0300

3 Littleton Rd Unit 1 | Westford, MA 01886
Westford/Chelmsford Line
(Formerly Of Chelmsford)

Please check Appointment Guidelines link before coming to your appointment it will help you understand the new procedures we need to follow.

Test Form

    Personal Information

    First and Last Name*

    Phone Number*

    Email Address*

    Date of birth*




    Zip Code*

    Do you wish to receive special weekly discounts via SMS (text messaging)? *

    How did you hear about us?*

    Are you on Instagram? Follow us! @aspatorememberwestford

    A Spa To Remember Skin Care Consent Form

    Are you pregnant? *

    Do you wear contact lenses? (Please remove contacts if eyes are sensitive or if having microdermabrasion treatment)*

    Do you currently have sunburn/windburn/red face?*

    Are you in the habit of going to tanning booths?*

    Do you currently get facial waxing/electrolysis?*

    Are you currently using Retin-A/Renova/Differin?*

    If so please answer the following questions: What Strength? For how long? How frequently?
    Where is it applied?

    Are you currently using Acutane?*

    Are you having a microdermabrasion treatment?*

    Do you have regular collagen injections?*

    Do you have regular botox injections?*

    What type of work do you do?*

    Airline travel? If so how often?*

    Do you participate in vigorous aerobic activity or sports?*

    Have you ever had a peel?*

    If so was it within that past 14 days?*

    What kind? Please describe your reaction.*

    Have you recently had a facial surgery?*

    Have you recently had any laser treatments?*

    Do you smoke?*

    Develop cold sores/fever blisters?*

    Are you affected by, or have any of the following:
    Check all that apply.

    Are you allergic/sensitive to?
    Check all that apply.

    Any other allergies?*

    Are you sensitive to alcohol based products? *

    Are you taking any medication at this time? (antibiotics increase sensitivity) *

    Are you using glycolic/AHA home care products? *

    If so which one(s)?

    Have you ever used any products that caused a bad reaction? *

    What is your daily home care regimen? *

    What are the cosmetic improvements you would like to see in your skin? *

    Payment Information

    We require a 24-hour cancellation notice or appointment rescheduling of all services.
    A Charge of 50% of the service will be incurred for all missed appointments.

    Please note that this card will only be charged in the case of a same-day cancellation or a no-show appointment, please bring in a separate payment method at the time of your service.

    Type of card*

    Name on Card*

    Card Number*

    Expiration Date*

    CVC Number*

    Please input your name, the date and signature below.