ODYSSEY SKIN LOUNGE INTAKE FORM

Name

First NameLast Name

Phone Number

Area CodePhone Number

Date of Birth (month/day/year)

TODAYS DATE

Date

How did you hear about Odyssey Skin Lounge?

List any medications, supplements, or herbal remedies you currently take:

Please list any allergies or sensitivities (including food, medications, etc.)

Please list any current injuries, if any:

Have you ever received a professional skin care treatment before?

Preferred Massage Pressure?

Please list any specific skin concerns (if any)

What is your daily skin care regimen?

Please check all that apply.

Have you ever used any of the following in the past 6 months/or are you CURRENTLY using any of the following?

Have you received any of the following in the past 2 months?

What is your goal for this session.

Would you like a quiet treatment?

Are you interested in product/future treatment recommendations that will treat your specific skincare concerns

Do you give permission for your esthetician to take before & after photos/videos of your treatment for $10 off your next service?

CANCELLATION/RESCHEDULE/LATE ARRIVAL/NO SHOW POLICY

Appointments canceled with less than a 24-hour notice will be charged 50% of the scheduled service

No-call/No-show appointments will be charged 100% of the booked service

Odyssey Skin Lounge has a 10 MINUTE grace period. After 10 minutes, the scheduled appointment will be canceled and charged as a No-Show (100% of the booked service).

Signature

I UNDERSTAND that redness, sensitivity, peeling, or other reactions may occur from a facial treatment. I further understand that my esthetician is NOT qualified to diagnose, prescribe, or treat any disease or illness and that a facial should not be replaced for medical treatments
I UNDERSTAND that the treatment may involve the risk of complication or injury and I freely assume those risks
I UNDERSTAND that facial results are not guaranteed and that for maximum results, more than one treatment may be required. The rate of improvement of my skin depends on my age, skin type, condition, degree of sun/environmental damage, pigmentation levels, acne condition, and use of professional skincare.
I UNDERSTAND that this intake form will be applied to to all future appointments. It is my responsibility as the client to upate this form as needed and to let my esthetician know of any changes that could affect my course of treatment

BY SIGNING BELOW, I certify that I have read the above information, I fully understand, and give my consent to treatment. The treatments I receive here are voluntary and I release Odyssey Skin Lounge and/or the Esthetician from all liability and assume full responsibility thereof.

Signature

CONSENT FOR FACIAL TREATMENT