New Patient Form

I have provided an accurate and complete medical history and have not knowingly omitted any information. I have had the opportunity to ask questions and receive answers regarding this medical history and I consent to my physician being contacted if necessary. I also understand that, I assume responsibility for any and all fees associated with the procedures and services.

To allow sufficient opportunity to accommodate other appointments, we require 72 hours’ notice for cancellations or changes to bookings for:
- Spa Packages or services requiring 2 hours or more.
- Group packages of 2 or more people
- All other services require 24 hours’ notice.
We reserve the right to charge a fee equal to 50% of the cost of service and may request a credit card number or deposit to reserve future appointments.*
All appointments requested online are NOT yet booked. A Breathe Spa Coordinator will contact you to confirm the appointment.
*Please Note: Half of payment is due at booking confirmation when two (2) or more guests are scheduled on the same day, booking any spa package, aesthetic package or holiday package, or any dollar amount over $150.00 before taxes. Prices are subject to change.