• Beauty Therapies - Client Consultation Form

    Please complete this beauty and health consultation e-form before your appointment. You do not have to share your personal data with us, but if you do not then we cannot offer you a treatment with Luna Beauty & Holistic Therapies.  You must fulfil your request for completing a client health form (share your personal information) in order for us to fulfil ours (carry out a treatment).

  • Please complete this form as honestly as you can do, if there is anything you don't feel you can write here, please feel free to let me know later as you feel more comfortable or please give me a ring.

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  • GP Name Name of Surgery/Medical Practice

  • If you plan to have more than one type of beauty treatment, please complete each section :-)

    • Facial Clients - open and complete this section  
    • Lash Lift Clients - open and complete this section  

    • LASH BOMB - LASH LIFT Disclaimer

      I understand that lash lifting and tinting has some inherent risk of irritation to the eye area, including the eye itself and could result in stinging or burning, blurry vision and potentially blindness should the product enter the eye.

      I understand that if the products accidentally meet my eye, my eye will be flushed with saline water and medical attention may be required. 

      I understand that there may be a residual staining left on the skin after the tinting process.  This will fade and go away within a short time.

      I confirm that I give my consent to carry out the Lash Bomb Lash Lift treatment.  The desired effect of the Lash Lift will be discussed with you prior to your treatment.

      A patch test is required 48 hours prior to a Lash Lift treatment (for lifting creams, tinting and lash glue). I understand that a patch test does not guarantee that an allergic reaction will not occur. If you have not had a patch test then your treatment will be deferred. If you test positive at any time for COVID19, you will require a further patch test. Patch tests need to be repeated periodically as per beauty industry guidance.  You will be asked to sign and date when you have had a patch test when you have your treatment.

      The information I have given is correct to the best of my knowledge.  I will follow the verbal and written aftercare advice given to me.  

       

    • Tinting clients - open and complete this section  

    • Tinting Disclaimer A patch test is required 48 hours prior to a Tinting treatment I understand that a patch test does not guarantee that an allergic reaction will not occur. If you have not had a patch test then your treatment will be deferred. If you test positive at any time for COVID19, you will require a further patch test. Patch tests need to be repeated periodically as per beauty industry guidance.  You will be asked to sign and date when you have had a patch test when you have your treatment.

    • Waxing Clients - open and complete this section  

  • CLIENT DISCLAIMER :- I accept that the Therapist can guarantee no specific results. I accept full responsibility for my own well-being and for reporting my physical and psychological health to my own GP/Consultant/Nurse.  I confirm that the above is a true statement and I am pleased for the Therapist to carry out the beauty treatment. I have read and understood the disclaimer. I am aged 16+.

    If aged below 16 - parent or guardian to sign this form below. Certain treatments are not possible below age 16, this will be discussed with you.

  • COVID19 -  I agree to tell the Therapist if I fall ill with Covid-19 either
    before or after my therapy appointment, with the understanding that the therapist may cancel/postpone my treatment if I contract Covid-19.  

    I consent to my treatment records and the information on this form to be kept securely under GDPR regulations.

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  • Luna Beauty & Holistic Therapies needs all the details above in order to ensure it is safe to provide a therapy treatment you may ask for and for insurance purposes.  Your client health form will be treated with the utmost confidentiality and security.  Paper copies of personal information is stored in a locked file.   Any email correspondence, SMS or Facebook messages containing personal data are password protected and secure.  Your information will be stored for 7 years after the date of your last treatment or for 7 years after you have reached the age of 18, if you are/were under 18 when your treatment took place.  The lawful basis for processing this personal information is contract; this means we have a legal reason to ask you for your data because it is needed for contractual reasons.  e-Newsletters are usually sent 3 or 4 times each year and we use a third party provider MailChimp to deliver emails.  Individuals can unsubscribe at any time from e-Newsletters. Full details available in Luna Beauty & Holistic Therapies Privacy Policy – July 2020 (published on website www.lunaholistictherapies.co.uk)                                                              

    COVID19 – If situation of a COVID19 infection arises, we will inform Test and Trace of contact details.  

     

  • Thank you for completing this form.  

    Your co-operation and custom is greatly appreciated at this time.

    We are taking every precaution over and above Government Guidance for Close Contact Services to ensure Luna Beauty & Holistic Therapies is a Covid19 secure salon.

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