Facial/ Chemical Peel Consent Form + Deposit Info

By signing this form, you have read POLICIES & INFO and agree to all terms and conditions.

This form is valid indefinitely.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
How old are you ?*
I am*

FemaleMaleN/A
Are you pregnant?*
Do you suffer from any allergies?*
Do you have any medical conditions?*
Do you have any infectious disease/s?
Have you experienced Botox, Restylane or Collagen injections? If so, When?*
Are you currently using any products that contain the following ingredients?*

RetinolRetin - ARenovaGlycolicN/A
Are you using any other Active Ingredients?*
What is your main skin concern?*
What is your current morning and night skincare routine? If any *
Any other Information I should be aware of?*
Would you like the bed heated?

YesNo
Would you like a blanket?

YesNo
I grant permission to gleam by gigi (Gisela Garcia) to take photos and videos and allow to be posted on social media.*

YesNo
I would like to be filmed for gleam by gigi social media content.*

YesNo
I acknowledge and understand*

I have given an accurate account of my medical history, including infectious disease/s, all known allergies or prescription drugs or products I am currently ingesting or using topically.The procedure and accept any risks. I do not hold the estheticians at gleam by gigi (Gisela Garcia) responsible for any of my conditions that may arise during or after facial treatment.This consent form does not have an expiration date
I Understand...*

I will not bring extra guests$40 Deposit is non refundable ( No exceptions)Deposit must be send when booking appointment, your appointment is not confirmed until deposit is sent.Gleam by gigi offers a 10 minute grace period. However, that will cut down on your time of service.If you arrive 10 minutes after your scheduled appointment we will have to reschedule, and another deposit will need to be send to rebook.
I will not

Wax 24-48 hours before or after appointmentGet botox or filler 2 weeks prior to scheduled appointmentBe out in the 48 hours before scheduled appointment.
I will arrive to my appointment with...*

No Eye or Face MakeupCleansed Skin
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

By signing this form, you have read POLICIES & INFO and agree to all terms and conditions.