• Basic Face Massage Intake Form

    Basic Face Massage Intake Form

  • Your Skin

  • Have you had a facial before?*
  • What are your specific skincare concerns?*

  • Give us an idea of what you typically use on your skin daily?*
  • Any known allergies?*

  • Have you ever been diagnosed with eczema, psoriasis or rosacea on the face?*
  • Are you currently using any products that contain:*
  • Have you ever received chemical peels, laser services, or microdermabrasion treatments?*

  • Have you had botox or fillers in the past 7 days?*
  • Your Medical History

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

  • Acknowledgement and Waiver I hereby agree to have this treatment be performed on me. I am aware that products used in facials and homecare can contain tree nuts, dairy and gluten. I acknowledge that the estheticians at Ink’d Lips may use products that contain these ingredients or are manufactured in a plant with these ingredients. I am aware that even with natural ingredients there is a remote chance of an allergic reaction and there is a possibility of an adverse reaction to product used in facials.  I am also aware that certain services should not be performed with certain medical conditions. I have disclosed all my known medical conditions, allergies, medications and answered all questions honestly on the above form and agree to update Ink’d Lips as to any changes. I acknowledge that the staff at Ink’d Lips do not provide medical advice and I accept full responsibility to seek out such advice before receiving any services or products from Ink’d Lips. I hereby release, discharge and waive any and all claims against Ink’d Lips and each of their partners, employees, representatives or any person(s) performing services or applying any products at Ink’d Lips, including from liability and responsibility for any and all illness, injuries, damages, claims, rights and causes of action of any kind or nature, that may occur during or arising out of any services or products received on this and any future dates. I expressly assume and accept the risk for any injuries sustained. I understand all my questions have been answered. I have read this entire document and agree to its terms.

  • Tips are not required but it’s a great way to show appreciation. 💖

  • Should be Empty: