Health and Consent Form

Health and Consent Form

Flicker Esthetics Studio
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Date of Birth *

MonthDayYear
Date
Flicker Esthetics currently accepts new clients on a referral basis in order to ensure booking availability for current clients. Please provide your referral’s name. *
How did you hear about us?
Have you received any of these services before? Select all that apply.*

Lash ExtensionsLash Lift/TintBrow TintFacial Waxing/Brow WaxLash Extension RemovalNone of the above

Consent & Policy Agreement
Please review the following terms below before signing;

Please be aware that there are possible risks/complications associated with all services. By signing below, you accept the results and possible complications of service. If you experience complications related to your services, you agree to contact Flicker Esthetics and consult a physician at your own expense if needed.
Flicker Esthetics services are performed using proper technique with your safety in mind. However, it is possible for tools and products used to cause irritation. In rare cases, if preexisting medical conditions/allergies exist, or proper aftercare is not followed, infection or allergic reaction may occur. By signing below you release the technician from liability if you develop an allergic reaction/infection as a result of the products/tools used during your service.
There are no guaranteed results and outcomes of service will vary. There are factors that may affect desired results such as; hormones, moisture/oil contact, weather conditions, and activities involving exposure to high temperatures/sweat.
Once post care instructions are received, you agree to adhere to such instructions. Failure to do so may jeopardize achieving desired results.

Policies

Late arrivals: Arrivals later than 15 minutes will be rescheduled.

No Shows: Will not be rebooked

Clients in Service Room: Only clients receiving services/legal guardians are allowed in treatment room.

Age: Clients must be at least 16 and clients under 18 must have a parent/guardian signed consent form.

Pricing – All prices quoted are subject to change without notice. All purchases and services are final, and there are no refunds.

Refusal of Service- We reserve the right to refuse services to anyone.
I am over 18 years of age or have a parent/legal guardian present and consent to the agreement, policies, and to treatment. I release Flicker Esthetics from all liability associated with services, which are performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. This agreement will remain in effect for this service and all future services conducted by Flicker Esthetics. *Please have a parent/guardian sign this portion if you are under 18 years old.**

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Optional: Request and Consent to Photography
I certify I am over the age of 18 or have a guardian present, am not under the influence of drugs or alcohol, and consent to be a Flicker Esthetics model for purposes such as social media and web marketing. *Please have a parent/guardian sign this portion if you are under 18 years old.

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Health and Consent Form

Consent & Policy Agreement

Optional: Request and Consent to Photography