Client Information & Consent Form

Client Information & Consent Form

Welcome to Flawless Beauti By Tia and thank you for choosing me to care for your skin, brows and waxing needs! I look forward to working with you!
Name

First NameLast Name
Take Photo (face only)
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthday

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
How did you hear about Flawless Beauti By Tia?
If you were referred, please provide the name of the person who referred you.
What services are you interested in? Please check all that apply.
Health History
Are you currently pregnant, breastfeeding or trying to become pregnant?
Prescribed medications you are currently taking?
*Please note that waxing services will be refused if you have recently used Retin-A, Accutane or other high percentage acne medications that will disrupt the integrity of the skin. Please type NONE if you are not currently taking prescribed medications.
Have you used any products containing alpha-hydroxy acid or glycolic acid in the past 48 hours?
Please list all known allergies.
*Please type NKA (no known allergies) if you have none.
Please select all current health conditions or health conditions you have had in the past.

Other
Skin Care History
Have you ever had a facial treatment before? If yes, what facial treatment and when?
What is your skincare goal?
Please selects all areas of concern you have regarding your skin

Other
Have you had any cosmetic injectables and/or filler products within the past 3 months? (Botox, Dysport, Juvederm, Restylane, Voluma etc.) If yes, give the date of your last appointment.
*Clients who have recently had cosmetic injectables and/or filler products will need to wait 14 days post injectable/filler appointment to receive brow and/or skincare services. If no, type No.
Do you wear sunscreen daily?
Client Acknowledgment & Consent
TEN MINUTE GRACE PERIOD: If you have not arrived for your scheduled appointment on time, after 10 minutes your appointment will be lost. At that time, I will give you the next available appointment IF there is availability. Please be on time to your appointment, however, I understand life happens. In the event that you are running late please text or call me to notify me of your tardiness.
CANCELLATION POLICY: Flawless Beauti By Tia requires a 24 hour advance notice for appointment cancellations or appointment rescheduling to avoid 50% of the services booked being charged. This allows other customers an opportunity to book an appointment during that time slot and this insures that I am being compensated for my valuable time.
NO CALL/NO SHOW APPOINTMENTS: ANY appointment that is a "no call" or "no show" will be subject to 100% of the services booked being charged. You will also be banned from booking online for any future services. Please be respectful of my business and my time.
e-GIFT CERTIFICATES: Flawless Beauti By Tia e-gift certificates can be purchased online through my booking site tiareid.glossgenius.com. e-gift certificates expire six months from the date of purchase. Flawless Beauti By Tia is not responsible for unused funds and will not notify you of expiring e-gift certificates. ALL SALES FINAL!
Do you give Flawless Beauti By Tia your consent to be videoed or to have your pictures taken during the duration of your service? These videos and/or pictures will be used for marketing purposes only and you will not be compensated.
I have thoroughly read and understand this client information and consent form and have answered each question truthfully. Questions that I have I will discuss with Tia Reid before signing. I understand that withholding information from my Aesthetician may result in contraindications or compromised skin integrity from services received. Brow, Waxing and Skincare services I receive at Flawless Beauti By Tia are voluntary and I release Flawless Beauti By Tia from liability and assume full responsibility thereof. I understand that Flawless Beauti By Tia will use this client information and consent form to make a professional judgement on the proper services to render to minimize the potential of adverse reactions to the best of her ability. Flawless Beauti By Tia has the right to refuse services if she does not deem the service safe to perform or if it is out of her scope of practice.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Client Information & Consent Form

Health History

Skin Care History

Client Acknowledgment & Consent