• Facial Client Intake and Consent Form (Confidential)

    Facial Client Intake and Consent Form (Confidential)

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  • Medical History


  • Female Clients Only:

  • Your Skin

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  • Photo Release and Consent

  • This consent form shall be used to obtain clients consent for photographs and videos to be taken by Flawless Fix and its staff.

    By signing this form, client affirms their understanding that the images may be used for different purposes indicated hereunder.

    I AUTHORIZE THE USE OF PHOTOGRAPHS FOR THE FOLLOWING: Educational purposes, Social Media, Print, Video and Television Marketing.

    By consenting to the release of images, client agrees that they will not receive any form of compensation.

    Client hereby waives their right to inspect of approve the photographs by which their likeness appears.

    Client likewise understands that their name will not be included in the images. Nonetheless, it is still possible that someone may still recognize the client.

    Clients refusal to consent to the release of photographs and videos will not in any way affect the services being provided.

    Client may rescind authorization to release photographs and videos by submitting a written request to Flawless Fix.

  • In the event of a minor, photos will not be used without written consent from parent or guardian.

  • COVID-19 Risk and Liability Release Waiver

    Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), our business is taking extra precautions with the care of every client to include health history review and enhanced sanitation/disinfecting procedures in compliance with CDC guidance.
  • I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.

    I further acknowledge that Flawless Fix has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.

    I further acknowledge that Flawless Fix can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, and other clients and their families.

    I voluntarily seek services provided by Flawless Fix and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.

    I agree to and affirm the following:
    * I affirm that I, as well as all household members, are not experiencing any covid related symptoms such as fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting or diarrhea.
    * I affirm that I, as well as all household members, have not traveled outside of the country or to any city considered to be a “hot spot” for COVID-19 infections within the past 30-days.
    * I affirm that I, as well as all household members, have not knowingly been exposed to anyone suspected and/or confirmed a with diagnoses of COVID-19 within the past 30 days.
    * I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 30 days.
    * I affirm that I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

    *I understand that Flawless Fix cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history
    provided by each client. 

    By signing below, I agree to each statement above and release Flawless Fix and its staff from any and all liability for unintentional exposure or harm due to COVID-19.

  • Client Consent and Waiver

  • By SUBMITTING AND SIGNING THIS FORM, I acknowledge, consent and agree to the following:

    I give my permission to receive facials, skin care treatments, eyelash and eyebrow services or waxing services.

    I understand that the esthetician does not diagnose illnesses or injuries, or prescribe medications.

    I have clearance from my physician to receive facials, skin treatments and waxing services.

    I understand the risks associated with facials and waxing include, but are not limited to:
    • Superficial bruising or redness
    • Short-term muscle soreness
    • Exacerbation of undiscovered injury

    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 (SPF45), I am more susceptible to sunburn, skin damage & hyperpigmentation. I should avoid excessive sun exposure.

    I acknowledge that this treatment is strictly an 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 not part of the recommended take-home regimen for 2-4 weeks following treatment.

    I understand the importance of informing my esthetician of all medical
    conditions and medications I am taking, and to let the esthetician know
    about any changes to these. I understand that there may be additional risks
    based on my physical condition.

    I understand that it is my responsibility to inform my esthetician of any discomfort I may feel during the session so he/she may adjust
    accordingly.

    I understand that I or the esthetician may terminate the session at any
    time.

    I have been given a chance to ask questions about the session
    and my questions have been answered.

    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, therefore, release Flawless Fix and its staff of from all and any liability associated with any injuries and /or current and future conditions resulting from the skincare procedures or products.

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