Pretty Please Haus of Vanity

Date

Name

First NameLast Name

Date of Birth

Date

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

How did you hear about us?

If referred, by who?

Are you currently under the care of a physician?

Have you experiences any of these health conditions in the past or present?

Any known allergies?

List medications/supplements you are currently taking.

Have you ever received any botox or fillers? if so, where and when?

Have you ever experiences claustrophobia?

Please rate your stress level

What are your skin concerns?

What would you say your skin type is?

What skin care products do you use on a daily basis?

Do you experience routine breakouts or acne?

Have you been diagnosed with eczema, psoriasis or rosacea?

Have you received any of these facial hair removal services in the last 7 days?

Do you currently use:

Are you currently using any products that contain:

Have you ever received chemical peels, laser services, or microdermabrasion treatments?

Do you?

Before & after photos will be taken. Do you consent to being photographed and/or filmed, for social media and educational purposes?

Are you taking birth control?

Are you pregnant or breast-feeding?

I acknowledge that I must adhere to Beauty Elevated LLC policies.

There is a 50% service fee for cancellations within 24 hours of the scheduled appointment. The cancellation fee is non-refundable and non-transferable.

There is a 75% service fee if you cancel your appointment 3 hours before the start of your scheduled service.

Please be sure to make ANY CHANGES to your appointment 24 hours prior to the start of your service. This includes having multiple services booked and changing it to just one service. Doing this after 24 hours will result in 50% charge of the late cancelled service.

There is a 100% service fee for any no shows. This service fee is non-refundable and non-transferable

Clients will have a 10 minute grace period for any appointment over 20 minutes and 5 minute grace period for appointments under 20 minutes. If client hasn’t arrived within 5 or 10 minutes, client will be marked as a no show and late cancellation fee will be applied.

By booking an appointment you agree to the cancellation, no show, and late policy.

I acknowledge that my skin might experience temporary irritation, tightness, redness or slight swelling which usually dissipates within 72 hours depending on skin sensitivity.

I acknowledge that if I am allergic to one or more ingredients in the products used, I may experience allergic reactions.

I acknowledge that if I fail to use a minimal sunscreen (SPF30), I am more susceptible to sunburn, skin damage & hyperpigmentation. I should avoid excessive sun exposure especially between 10am-2pm.

I acknowledge that this treatment is strictly elective cosmetic procedure and no medical claims have been expressed or implied.

I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, waxing, and products containing acids that are no part of the recommended take-home regimen for 2-4 weeks following treatment.

I consent (to the best of my knowledge) that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment. I give consent for all future treatments

I release Beauty Elevated LLC and its staff of any liability associated with any injuries and /or current and future conditions resulting from the skincare procedures or products.

Signature

Beauty Elevated LLC

Your Medical History

Your Skin

Females Clients