Pretty Please Haus of Vanity

GlowUp Skin Spa

Facial Consent Form
Date*

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Any known allergies?*

AsprinLatexFruitsShellfishLidocaneFragrance/essential oilsTree NutsDairySunscreenPollenNoneOther
Your Skin
What are your skin concerns?
What would you say your skin type is?

Normal (no visible blemishes, fine pores, smooth texture)Sensitive (reactive to fragrance, often irritated)Combination (oily and dry patches, oily t-zone, hormonal breakouts)Oily (enlarged pores, excessive oil)Acne (cystic or nodules)Dry (dull, visible lines and wrinkles, feels tight)
Females Anatomy Clients
Are you pregnant?

YESNO
I consent to before/after pictures that maybe be used on social media platforms

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

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

I consent 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 GlowUp Skin Spa LLC and esthetician of any liability associated with any injuries and /or current and future conditions resulting from the skincare procedures or products.
I acknowledge that I must adhere to GlowUp Skin Spa's policies. I understand that cancellations must be done with at least 24 hours notice Failure to do so will result in 50% of the total service cost. I acknowledge that ANY no show will result in 50% of the total service cost. I understand that after 15 minutes of tardiness my appointment may be subject to cancellation and I will be responsible in accordance with the “ No-show” policy.
Signature

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GlowUp Skin Spa

Your Skin

Females Anatomy Clients