• Confidential Client Intake Form

    Confidential Client Intake Form

    Important: PLEASE READ CAREFULLY AND SIGN
  • Format: (000) 000-0000.
  • Medical History (please check all that apply):*
  • Are you currently taking any medications?:*
  • Have you had any facial or dermatology services in the past 30 days?:*
  • - Do you have any allergies?*
  • Skin care History- Check the products that you currently use (please select all that apply):*
  • What type of skin do you have?*
  • Conditions you are currently experiencing today (please select all that apply):
  • Importante Information - What concerns do you have regarding your skin? Please select all that apply:*
  • Have you been under the care of a dermatologist within the past year?*
  • Have you used Retin-A, Renova, AHAs or Retinal/Vitamin A products in the last three months?*
  • Have you received Botox, Restylane, or Collagen injections in the last 6 months?*

  • By signing below, I agree to the following:

    I have completed this form to the best of my ability and knowledge. I agree to inform the technician of any changes in the above information. I agree that I do not have any condition(s) that would make the requested treatment unsuitable. I will inform the technician of any discomfort I may experience at any time during my treatment to allow them to adjust accordingly. I agree to waive all liability toward my technician and the salon for any injury or damages incurred due to any misrepresentation of my health.
  • Date*
     / /

  • Client Consent Form & Liability Waver

    Important: PLEASE READ CAREFULLY AND SIGN

  • I hereby consent and authorize Honey Aesthetic LLC to perform the following procedures I have scheduled.  

    I have voluntarily elected to undergo the treatment/procedure after the nature and purpose of this treatment have been explained to me.

    I understand and acknowledge that there are risks involved with the treatment I will be receiving. Although it is impossible to list every potential risk and complication, I have been informed of possible benefits, risks, and complications, and I have had the opportunity to ask questions regarding these risks and other possible complications.

    I also recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle, and that there is a possibility I may require further treatments of the treated areas to obtain the expected results at an additional cost.

    I have read and understood the post-treatment home care instructions. I understand how important it is to follow all instructions given to me for post-treatment care. 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 have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically. I will inform my treating esthetician when scheduling an appointment of any medications/drugs/pregnancies and changes to my medical history, failure to do so you agree and will assume the risk and full responsibility for any, and all injuries, losses, side effects, or damages that might occur while doing any procedures scheduled.

    I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. I agree I will assume the risk and full responsibility for any and all injuries, losses, side effects, or damages that might occur to me while I am undergoing this procedure. I do not hold the esthetician, doing my treatment, responsible for any of my conditions that were present, but not disclosed at the time of this skincare procedure, which may be affected by the treatment performed the day of the appointment.

  • Date*
     - -

  • Photograph and Video Release Form

    This form is not required to be signed if you don't feel comfortable getting your pictures taken. If you would like to get your pictures taken, but would like your identity to be covered you must sign below and let your treating Esthetician know.

  • I       hereby grant and authorize Honey Aesthetics LLC the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures, video, and/or audio is taken of me to be used in and/or for any lawful promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, press kits, websites, social networking sites, and other or digital communications without payment or any other consideration. This authorization extends to all languages, media, formats, and markets now known or later discovered. I waive the right to inspect or approve the finished product wherein my likeness appears, including a written or electronic copy. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I hereby hold harmless and release Honey Aesthetics LLC from all liability, petitions, and causes of action I, my heirs, representatives, executors, or any other persons may make while acting on my behalf or on behalf of my estate.

             Pick a Date   

  • Covid-19 Liability Release Form

    Due to COVID-19, we are taking extra precautions with each client and have improved our sanitation and disinfecting practices. Please complete the following and sign below.
  • I confirm that I, nor anyone in my household have any of the following symptoms of COVID-19 listed below, nor have had any of the following symptoms in the past 14 days

  • *To the best of my knowledge, neither I nor anyone in my household has been in contact with anyone who has tested positive for COVID-19. *


    *I verify that neither I nor anyone in my household has traveled outside of 14 days.*

    *I understand that the CDC recommends social distancing of at least 6 feet, and this is not possible with the service I am receiving today. *

  • Date*
     / /

  • Cancellation Policy

    When Scheduling an Appointment you Agree to Abide by the Below Conditions.

  • Your appointment is very important. We understand that sometimes schedule adjustments are necessary. Therefore, we respectfully request at least 12 hours' notice prior to your scheduled appointment time for cancellations or rescheduling of appointments. Please notify us by e-mail if your cancellation is outside of our normal business hours or you're unable to reach us by phone at (346) 218-4754.

    **ANY APPOINTMENTS CANCELLED/RESCHEDULED OR CHANGED WITHOUT 12 HOURS NOTICE WILL RESULT IN A 30% CHARGE OF THE RESERVED SERVICE AMOUNT. ALL THAT IS 10+ MIN LATE WILL BE CONSIDERED A NO-SHOW AND  WILL BE CHARGED 30% OFF ALL SERVICES SELECTED, AND WILL NOT BE SEEN ON THE DAY APPOINTMENT WAS SCHEDULED.**

    We recognize the time of our clients and estheticians, is valuable and have implemented this policy for this reason. When you miss an appointment with us, we not only lose your business but also the potential business of other clients who could have scheduled an appointment for the same time.

    Please remember that it is your responsibility to remember your appointment dates and times in order to prevent any missed appointments which result in a cancellation fee. Not receiving an electronic notification of your appointments from us is not sufficient reason to miss an appointment if the original confirmation notification was received timely.

    It is mutually understood that if a cancellation is due to circumstances beyond any of our control, such as power outage, unfortunate incidence, illness, or weather that requires you or us to have to cancel or be closed during regular business hours, we will reschedule your existing appointment and no discount or rescheduling fee will apply.

    I have read and understood the cancellation policy and agree to abide by the above conditions.

  • *   *  *  Pick a Date*   

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