Jardin Secret Spa/Wellness Center

Client Form 4 – Perineum Aromatherapy (Yoni/Vaginal Steam) Consent Form

Client Information

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Emergency Contact Information

Description of Service
Perineum Aromatherapy, also known as Yoni or Vaginal Steam, is a holistic health treatment where a woman allows the warmth of herbal steam to permeate the exterior of her vagina. The treatment is designed to promote relaxation, relieve menstrual discomfort, support postpartum recovery, and enhance overall feminine wellness.
I have read and understand the description of this service.
Clear Signature
Possible Side Effects

After the procedure, you may experience increased vaginal discharge, mild cramping, or changes in your menstrual cycle. These are generally normal and temporary responses as your body adjusts to the treatment.

Some possible side effects include:
  • Skin irritation or itching
  • Sensitivity to heat
  • Allergic reactions to herbs used
  • Increased vaginal discharge
  • Mild cramping
I have read and understand the possible side effects of this service.
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Patient Consent
  • - I understand that results may vary upon individuals.
  • - I understand that I may need multiple treatments to achieve desired results. I understand that at-home care and lifestyle adjustments may be required to achieve optimal results.
  • - I am NOT pregnant or currently menstruating. I understand that this treatment is not recommended during pregnancy or menstruation.
  • - I do not have any infections, open sores, or lesions in the vaginal area.
  • - I have disclosed any allergies or sensitivities to herbs or other products.
  • - The procedure and potential side effects have been explained to me. I am advised that though good results are expected, the possibility and nature of complications cannot be accurately anticipated, and there can be no guarantees expressed or implied either as to the success or other results of the treatment.
  • - I understand that this is a holistic treatment does not a substitute for medical care. I will consult with my healthcare provider for any medical concerns.
I have read the above statements and consent to this treatment.
Clear Signature
I understand that I will undergo Perineum Aromatherapy (Yoni/Vaginal Steam) treatment and fully consent to have this procedure performed. I release Jardin Secret Spa/Wellness Center, its staff, and specific technicians from liability associated with this procedure.