A Spa to Remember | 3 Littleton Road Westford, MA 01886

( Do Not Confuse us with A Spa For You)


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.

A Spa To Remember Skin Care Consent 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.

    Sign Electronically in the empty space below: