• Service Consent Form

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date of birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • How did you hear about us?*

  • Service / Treatment Consent Form

    I acknowledge that my skin might experience temporary irritation, tightness, redness or slight swelling which usually dissipates within 72 hours depending on skin sensitivity. I acknowledge that if I am allergic to one or more ingredients in the products used, i may experience allergic reactions. I acknowledge that if I fail to use a minimal sunscreen (SPF45), I am more susceptible to sunburn, skin damage & hyperpigmentation. I should avoid excessive sun exposure especially between 10am-2pm. I acknowledge that this treatment and/or service is strictly elective cosmetic procedure and no medical claims have been expressed or implied. I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, waxing, and products containing acids that are no part of the recommended take-home regimen for 2-4 weeks following treatment. I consent (to the best of my knowledge) that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment. I give consent for all future treatments I release Beauty Lounge by Daisy of any liability associated with any injuries and/or current and future conditions resulting from the skincare procedures or products.

  • Photograph & Video Release Form

    I hearby grant Beauty Lounge By Daisy permission to the rights of my image, likeness and sound of my voice as recorded on audio or video tape. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Photographic, audio or video recordings may be used for the following purposes:

    Instagram reels/posts

    Websites

    Informational presentations

    Social Media

    Educational videos 

     

    By signing this release, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the internet or in the public educational setting.

    I will be consulted about the use of the photographs or video recording for any purpose other than those listed above.

    There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

    This release applies to photographic, audio or video recordings collected, video clips and image, online, and Social Media channels as part of the sessions listed on this document only.

    Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.

    By signing this form, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hearby release any and all claims against any person or organization utilizing this material for educational purposes.

  • **Thank you for taking the time to fill out this pre-appointment health check before your appointment.

     

    Due to the 2019-2020 outbreak of the Coronavirus (COVID-19), Beauty Lounge By Daisy is taking extra precautions with the care of every guest to include a health history review and enhanced sanitation/disinfection procedures in accordance with the Local, State and CDC guidelines.

    Symptoms may appear 2-14 days after exposure to the virus. People with these. Symptoms may have COVID-19.

    • Fever or chills
    • Cough
    • Shortness of breath or difficulty breathing
    • Fatigue
    • Muscle or body aches
    • Headache
    • New loss of taste or smell
    • Sore throat
    • Congestion or runny nose
    • Nausea or vomiting
    • Diarrhea

     

    *This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19.

    I agree to the following:

    I understand the above symptoms and affirm that I, as well as all household members, do NOT currently have, nor have experienced the symptoms listed above WITHIN THE LAST 14 DAYS.

    I affirm that I, as well as all household members, have NOT been diagnosed with COVID-19 WITHIN THE PAST 14 DAYS.

    I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 WITHIN THE PAST 14 DAYS.

    I affirm that I,as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 14 DAYS.

    I waive all liability of Beauty Lounge By Daisy if I unavoidable contract COVID-19.

    I understand that due to the frequency of visits of other clients, the characteristics of the virus, that I have elevated the risk of contracting the virus by being in a public setting, such as this location and accept that risk.

    I understand the COVID-19 virus has along incubation period, during which carriers of the virus may not show any symptoms and still be highly contagious. It is impossible to fully determine who is positive and who is not, given the current limits of screening in this location and I accept the risk.

     

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