Facial Consent Form

Consent Form
Client Name

First NameLast Name
Date of birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please take a moment to answer the following questions
Are you presently taking any medications?
Please list
Are you pregnant?
Do you have any allergies to cosmetics, food or drug?
Please specify any allergies:
What skin care products do you currently use?

Other
Please specify
Please select if you have any of these diseases.
Have you had skin cancer?
Do you use acne medication?
Are you taking oral contraceptives?
Please check if you are affected by or have any of the following
When was your last facial?
Do you agree to pics/video being taken as well as posted on social media and possibly used as marketing material for my business?
By signing below you are authorizing DK beauty bar to take pics/video as well as using them for marketing purposes.
Precare and Aftercare:

Stay out of direct sunlight, wear spf, avoid glycolic/retinols/retin-A/Tret/Trevino in/exfoliation products, and avoid picking/touching face. Avoid working out/sweating, and saunas 48 hrs after facial.

If you are sunburned, I will not perform a facial on you until your skin has fully healed.

I also cannot perform a facial if you come in less than 2 weeks from your Botox appointment.
By signing you agree to the precare/aftercare as described as above
Date

MonthDayYear
Date
By signing below you agree that you're happy with services rendered by Danielle, DK Beauty Bar
Signature
Should be Empty: