Age Spots
Facial, Neck, Chest, Redness
Acne Scars - Forehead,Cheeks, Chin
Acne Scars - Neckline, Shoulders, Back
Active Acne  - Forehead, Cheeks, Chin
Active Acne - Neckline, Shoulders, Back
Wrinkles, Fine Lines - Neckline
Wrinkles, Fine Lines - Forehead
Wrinkles, Fine Lines - Around Mouth
Have you ever had surgery?
Do you wear contact lenses?  If yes, what kind?
Do any of the following apply to you?
Varicose Veins
Blood Clots
Heart Problems
Blood Pressure Problems
Cancer
What concerns would you like to have addressed?
(Please select all that apply):
Do you take birth control? Hormone replacements?
If so, which one and for how long?:
Do you have any drug allergies?  Which drugs?:
Please list any current medications that you take,
including any over-the-counter or supplements:
Please list any ONGOING HEALTH CONDITIONS:
Do you have any tense or sore areas that require special attention? 
Arthritis
 
Do you use any oral / topical antibiotics? List which ones and for how long?:
Do you have any skin problems?  If yes, please describe?
Are you pregnant?  If yes, what trimester are you in?
Do you have any allergies?  Please describe?
Do you have any spinal problems?  Please describe?
If yes, what kind and how often?
Do you exercise regularly or participate in any sport?.
Do you take any prescribed medication?   Please describe?
Please indicate any specific treatments of interest:
   Please answer all questions specifying  "No" or "None" when necessary
Are you currently using Acutane, Retin- A, Renova or Defferin?
If so, how long?:
   Please answer all questions specifying  "No" or "None" when necessary
Have you had a professional massage before?
I understand that massage therapy given here is for the purpose of stress reduction, relief from muscular tension or spasm, or for increase of circulation and energy flow. I understand that the massage therapist does not diagnose illness, disease or any other physical or mental disorder. As such, the massage therapist does not prescribe medical treatment or pharmaceuticals, nor does he/she perform any spinal manipulations. It has been made very clear to me that massage therapy is not a substitute for medical examinations and/or diagnoses, and that it is recommended that I see a physician ailment that I may have.

Because the massage therapist must be aware of existing physical conditions, I have stated all of my known medical conditions and take it upon myself to keep the message therapist updated on my physical health.
Client Acknowledges Massage Therapy Agreement Terms
Massage Therapy Agreemernt Terms
Submit  Registration Information
City
First Name
State
Address / Unit #
Select Service(s)
Last Name
Zip
Home Phone
Cell Phone
E-mail Address
Preferred  Contact Method
Birthday (Month / Day)
How Did You Find Us?
Occupation:?
Check if you are interested in setting up a complimentary consultation with  our Physician Assistant?   (Medical Grade Procedures).
 
MASSAGE THERAPY
RetinA
Hydroquinone
Aspirin
Latex
If yes, please specify
Alpha-Hydroxy Acid
Wax
Retinol
Preservatives
Sulfadrugs
Fragrances
Are you sensitive/allergic to any of the following?
SKINCARE New Client  Registration
Skincare and Massage Services
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Privacy Policy
This privacy policy sets out how Peaches and Cream® Med Spa uses and protects any information that you give Peaches and Cream® Med Spa when you use this website.

Peaches and Cream® Med Spa is committed to ensuring that your privacy is protected. You can be assured that it will only be used in accordance with this privacy statement.

Peaches and Cream® Med Spa, from time to time, will notify customers (who sign up to receive email, direct mail and or text messages) of promotions and sales. 

Customer information is only used for this purpose and will not be sold or shared with any other third party. Any concerns please contact us.

The Peaches and Cream® Med Spa  website is SSL Certified and uses  high grade encryption technology to protect your information.

Please review our Terms of Service  to learn more.
 
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626-335-7313

138 N Glendora Ave Glendora CA, 91741    626-335-7313
Monday  9 AM - 5 PM         Tues - Thurs 9 AM - 9 PM         Friday 9 AM - 5 PM        Saturday 9 AM - 5 PM        Sunday 9 AM - 4 PM   
Copyright © Peaches and Cream® Med Spa 1984 - 2017

Check to receive E-mails regarding future specials and discounts?
For your convience you can register online prior to your spa appointment.  To better serve you, we ask you to compete the following questionare.  There are two sections: Skincare & Massage Therapy.   Complete the section(s) that apply to your service interests..
Do you, or does anyone in your family have a history  of seizures?:
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