Spray Tanning
Consultation Form
Name
First Name
Last Name
Email
example@example.com
birthdate
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Have you shaved/waxed in the last 24 hours?
Yes
No
Have you had a patch test?
Yes
No
If not please confirm you are happy to proceed with your treatment
Yes, I am happy to proceed
No, I will reschedule
Have you had any surgery or medical treatment in the last 12 months?
Do you suffer with any respiratory problems?
Yes
No
Are you pregnant or breastfeeding?
Yes
No
Do you have any skin or pigmentation disorders?
Yes
No
Is your skin hypersensitive?
Yes
No
Have you known any allergies?
Yes
No
Have you any open cuts/wounds/rashes?
Yes
No
Do you wear contact lenses?
Yes
No
Have you applied deodorant or moisturiser today?
Yes
No
Have you brought loose dark clothing for your tan?
Yes
No
Is the tan for a special occasion?
Yes
No
What was your experience?
Have you had a spray tan or used tanning products before?
Yes
No
What color tan would you like to achieve?
How well do you tan in the Sun?
Any questions?
Disclaimer: I declare that I have read and understood and answered the questions to the best of my knowledge. I have no known medical conditions or allergies that may affect or induce a harmful reaction from a sunless tanning treatment. The information above is for the therapists records only and will not be misused or passed on to any other third-parties.
Signature
Date
-
Month
-
Day
Year
Date
Submit
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