Spa By Di Vine and Wellness Institute

1124 Glade Rd. Suite 140, Colleyville, TX 76034

817.673.2111 –





The monthly Di Vine membership program will allow our clients to take their skincare maintenance program to the next level by providing regular monthly treatments at a significant discount.

  • The Di Vine Membership of $99 per month will include one IPL treatment of up to 30 minutes or $149 for up to 60 minutes.

Please select an option:

  • $99 for up to 30 minutes per month

  • $149 for up to 60 minutes per month


  • Members are entitled to receive one 30 or 60 minute treatment every month. / 4 or 6 weeks

  • Any unused services will expire should you elect to cancel your membership.

  • Unused services cannot be carried over to the next month. Unused services will be forfeited.

  • Unforeseen circumstances (such as extended illness, military service, or temporary relocation) cause a member to need to suspend their membership. A member may suspend their membership for up to a total of 3 months during the contract period by providing written notice 30 days prior to the beginning of the date the suspension is to begin. This will extend the contract period by the number of months the membership is suspended. (i.e. from 12 months to a maximum of 15 months if suspended for 3 months). During a period of membership suspension, your account will not be charged the monthly dues and you may not receive any accumulated services.

  • Please note that your membership services are not transferrable and must be used by the member enrolled in the membership program.

  • Please make sure to schedule your monthly treatment in advance in order to receive your preferred date and time.   

  • We do have a 24-hour cancellation policy, or you can lose your appointment at your own cost.

  • Monthly Membership does not include gratuities.

  • Membership services can not be combined with any other special offer.


Spa By Di Vine and Wellness Institute reserves the right to cancel any membership at any time.

A valid ID and credit card are required to enroll into the Di Vine Monthly Membership. You agree to provide Spa By Di Vine and Wellness Institute with updated information if your address or payment information should change. If Spa By Di Vine and Wellness Institute is unable to process the automatic monthly membership dues, the membership will be suspended pending payment in full. Any accumulated services will be forfeited if the membership is suspended due to nonpayment.



Spa By Di Vine and Wellness Institute reserves the right to cancel or suspend the membership of any member in the event of the following.


  1. The member commits a serious breach of the agreement and/or Spa By Di Vine and Wellness Institute rules and regulations.

  2. Where any monies are due to Spa By Di Vine and Wellness Institute by the member remain unpaid for 30 days after its due date for payment.

  3. May not be combined with any other promotional offer, gift card or 3rd party payment.

  4. The member knowingly provides false details when applying for membership and the false declaration would have reasonably affected Spa By Di Vine and Wellness Institute’s decision to grant the membership.

  5. If Spa By Di Vine and Wellness Institute terminates for any reason, they reserve the right to retain any monies received to cover any reasonable costs they have incurred as a result.

4. Automatic Payment Agreement – Please initial each line

  1. The membership period shall be for a period of six OR twelve months. A member shall not be entitled to terminate or suspend his/her membership during the period. If member has completed service and it is no longer needed, contract may be terminated by management’s discretion. _____

  2. This agreement is personal to the member and may not be assigned, transferred or otherwise disposed of by the member. _____

  3. Applicants for the membership must be 18 years old. _____

  4. Services and membership will only be allowed if client is signed off by spa medical director _____

  5. Monthly membership payments shall be made in advance by direct debit from the member’s designated credit/debit account. This information will be kept on file by Spa By Di Vine and Wellness Institute. _____

  6. Spa By Di Vine and Wellness Institute reserves the right to review subscriptions periodically. Members will be given at least 30 days’ notice in writing of any changes, which include: (i) any increase in membership fee, (ii) change in date of automatic withdrawal _____


I hereby agree to the Automated Membership Agreement as stated above.


Print Name __________________________________

Signature    __________________________________

 Date ________________


Credit Card Authorization

Type of Card: _______________________

Card Number: _________--_________--_________--_________

Expiration Date: _________/_________

CCV Code (three digits on the back of the card):_________

Cardholder Name: _____________________________________

Billing Address: Number:__________ Street: ___________________________ Suite or #: ________________

City: ___________________________ State:___________________________ Zip Code: _________________


I hereby authorize Spa By Di Vine and Wellness Institute to charge my card above per the terms of this membership agreement.


Signature: __________________________________  Date: ____________________________

© 2020 Spa By Di Vine. All rights reserved.