Todays Date: June 11, 2026
Member Name:
Phone Number:
Email Address:
Membership Type:
Membership Start Date for Hold (please pick 1st date of corresponding month you would like membership to be frozen):
Allotted time of freezing my membership (how many months):
We do allow our clients to freeze their memberships a maximum of once a year up to 2 months in total. You must give 10 days written notice by email (info@skinlogicmedspa.com) to freeze your membership or fill out this form 10 days prior to the end of the month. Your membership cannot be frozen past 2 months within the membership year. This specific allotted time cannot be extended or given retroactively.
For Office Use Only
Membership/Plan ID: ____________________________
Membership Freeze Start Date: ____ / ____ / ____
Membership Freeze End Date: ____ / ____ / ____
Processed By: ____________________________
Final Confirmation: By signing below, I confirm my request to freeze my Skinlogic Med Spa membership as of the specified date and agree to the terms and conditions listed above.
