Client Liability Form

Client understands and agrees that this Consent relates to the performance of certain services by Ashley McBroom (“Esthetician”), and that although Esthetician rents its workplace from Gregory Dylan Skincare & Beauty / Boy Meets Beauty, LLC, (i) Gregory Dylan Skincare & Beauty / Boy Meets Beauty, LLC shall bear no responsibility whatsoever for any damages, obligations or other issues that may arise in connection with such services, and (ii) Esthetician alone shall be responsible for all damages, obligations, or other issues arising therefrom.

We appreciate your business. So that we can best serve all our clients, please be advised of these policies.

ARRIVAL TIME

Due to regulations from the Los Angeles County Health Department in regards to COVID-19, we request that you stay in your car if you arrive at your appointment early. If you arrive after your scheduled appointment time, it may not be possible to extend the time available for your booked service; if your service is shortened due to your late arrival, you may still be charged the full cost of the service.

CANCELLATION & NO- SHOW POLICY

A credit card is required when booking an appointment. A 24 hours’ notice is required to reschedule or cancel a booked appointment, except in cases of contagious illness as described below. Appointments that are cancelled after 24 hours will be charged 50% of the services(s) that would be rendered. No- show appointments will be charged 90% for the service(s) that would have been rendered.

SICKNESS OR FAMILY EMERGENCY

If you, or another person in your household, has an infectious or contagious illness (COVID-19, influenza, etc), please contact us as soon as possible to reschedule your appointment for a later date. There is no penalty or timeframe required in this case, for your safety and that of other clients

Name*

First NameLast Name

Name of Parent/ Guardian (if client is a minor)

First NameLast Name

Pronouns

Phone Number*

Area CodePhone Number

Email*

example@example.com

Have you used any Alpha Hydroxy Acid (glycolic or lactic) or Beta Hydroxy Acid (salicylic) or enzyme products in the past 48-72 hours?*

YESNO

Are you using Retin-a, Renova or Accutane (an oral form of Retin-a)? *

YESNO

Are you on any blood thinning medications or medications that compromise the skin*

YESNO

I consent to “before-and-after” photographs for the purpose of documentation, potential advertising, and promotional purposes. (All photos can be cropped and not tagged for anonymity)*

YESNO

Are you pregnant and/or nursing?*

YESNO

Do you have any allergies? (i.e. nut allergies, sensitivity to fragrances or essential oils, etc) (Optional)

optional

Do you have medical conditions that might be a contraindication to the service(s) you will receive today? (i.e. cancer, diabetes 1/2, autoimmune disorder, etc) (Optional)

optional

Please note that waxing does have certain side effects such as skin removal, redness, swelling, tenderness, etc.

I have read the above information and if I have any concerns, I will address these with my skin therapist. I give permission to my therapist to perform the waxing procedure we have discussed and will hold them and their staff harmless from any liability that may result from this treatment. I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. I have read and understand the post-treatment home care instructions. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product / post-treatment care, I will consult the esthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the esthetician, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.

Date*

Date

Signature

Client Liability Form

COVID-19 Waiver