Elara Consultation Form
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  • Consultation Form

    Elara Med Spa & Laser is committed to client confidentiality, safety, and professional care.
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  • Date of Birth:*
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  • SERVICE INTEREST

  • Which service(s) are you interested in today? (Select all that apply)*

  • TREATMENT & MEDICAL HISTORY

  • Have you had any aesthetic or cosmetic treatments within the last 4 weeks?*
  • Are you presently taking any medications?*
  • Are you pregnant or breastfeeding?*
  • Do you have allergies or reactions to cosmetics, skincare products, foods, nuts, fruits or berries?*
  • Do you have a history of dark marks after irritation, acne, cuts, or insect bites?

  • LIFESTYLE & SKIN PROFILE

  • What are your stress levels like?*
  • What is your natural skin tone?

  • CURRENT SKINCARE & PRODUCT USE

  • What skin care products do you currently use?

  • MEDICAL CONDITIONS & HEALTH HISTORY

  • Have you had skin cancer?
  • Are you taking oral contraceptives or hormone therapy?*
  • Please check if you are affected by any of the following:*

  • COSMETIC TREATMENT HISTORY

  • Have you ever had injectables or cosmetic enhancement treatments before? (Botox, fillers, fat dissolving, etc.)*
  • Have you recently had dental work, cosmetic procedures, or facial treatments?*
  • Are you currently on blood thinners, weight-loss injections, or hormone-related medications?*

  • PHOTO & VIDEO MARKETING CONSENT

  • Do you give Elara Med Spa & Laser permission to capture and use photos or videos of you and your treatment session(s) for social media and marketing purposes?*

  • If "Yes", please read and acknowledge the following:

     

    • I give Elara Med Spa & Laser permission to photograph and/or record video during my treatment session(s) for use in promotional, educational, and social media content. 
    • I understand that content may be posted on Instagram, Facebook, TikTok, the Elara website, and other marketing platforms.
    • I understand that all content remains the property of Elara Med Spa & Laser and may be edited, altered, or shared publicly.
    • I understand declining photo/video consent will not affect my ability to recieve services.

  • CLIENT CONSENT, TERMS & CONDITIONS

  • Thank you for choosing Elara Med Spa & Laser. By signing this form, you confirm that you understand and agree to all policies in this document. This consent applies to all current and future appointments unless updated in writing.

     

    1. Consent to Services

    I voluntarily choose to receive aesthetic services at Elara Med Spa & Laser. These may include, but are not limited to: facials, dermaplaning, chemical peels, microneedling, laser hair removal, laser tattoo removal, fat-dissolving injections, neuromodulators or fillers if offered, and any future cosmetic treatments added by the clinic.

     

    2. Accuracy of Information and Contraindication Disclosure

    I confirm that the information I provide regarding my health, medications, skincare, and medical conditions is complete and accurate. I understand that undisclosed medical conditions, recent procedures, infections, or medications may increase risk. I accept full responsibility for any reaction or complication caused by incomplete or inaccurate disclosure and agree to update the clinic before any future treatment.

    I understand wothholding medical or skincare information may increase the risk of complications or affect treatments results. 


    3. Cosmetic Nature of Services

    I understand that all services at Elara Med Spa & Laser are cosmetic in nature and not intended to diagnose, treat, or cure any medical condition. These services do not replace advice or care from a licensed physician.

     

    4. Treatment Risks and Possible Reactions

    I understand that aesthetic treatments may cause side effects including but not limited to:

    redness, sensitivity, irritation, inflammation, swelling, bruising, dryness, peeling, flaking, breakouts, purging, texture changes, lumps or firmness at injection sites, pigmentation changes including hyperpigmentation or hypopigmentation, scarring, delayed healing, allergic responses, temporary discomfort, or any unexpected skin or body reaction.
    I acknowledge that every person’s skin reacts differently.

    I understand c;iemts with melanated or sensitive skin may haveincreased risk or temporary or prolonged hyperpigmentation or hypopigmention.

     

    5. Sanitation and Safety Acknowledgment

    I understand that Elara Med Spa & Laser follows strict sanitation and hygiene standards. All tools, linens, and treatment areas are disinfected professionally. 

     

    6. Expectations, Result Variations, and Timeframes

    I understand that results vary from person to person. No outcome is guaranteed. Photos seen online or in marketing represent individual results and may not reflect my own.

    My anatomy, age, skin type, lifestyle, genetics, and aftercare all influence my results.

    Results may take weeks or months to appear depending on the service.

    Slow progress or subtle change does not indicate ineffective treatment.

    Results vary based on individual skin response, hormones, medications, consistency, genetics, and lifestyle.

     

    7. Pre-care, Aftercare, and Product Use

     I agree to follow all pre-treatment and aftercare instructions.

    I understand that using unapproved products, harsh exfoliants, scrubs, oils, or chemical treatments may interfere with results or cause irritation.

    I accept responsibility for outcomes caused by improper aftercare or product use outside the provider’s recommendations.

    Failure to follow aftercare instructions may increase risk of irritation, complications, or unsatisfatory reslts.

     

    8. Limitations of Liability for Treatment Reactions

    I understand that Elara Med Spa & Laser, its owners, founders, proprietors, directors, officers, employees, contractors, affiliates, and investors are not personally or professionally liable for any adverse reactions caused by:

    withholding medical information, allergies known or unknown, failure to follow aftercare, misuse of at-home products, the body’s natural healing response, pre-existing skin conditions, sun exposure, picking or scrubbing the skin, lifestyle choices, hyperpigmentation or irritation, or any outcome beyond the provider’s control.

    I fully release the business and all individuals affiliated with it from any claim related to the services received.

     

    9. Injectables and Fat-Dissolving Treatments

    I understand that injectable procedures are elective and may require multiple sessions.

    These are not weight-loss treatments. Swelling, firmness, and tenderness are normal.

    Additional vials, touch-ups, or maintenance sessions may be required and are not included unless stated.

    I understand swelling, bruising, tendeerness, firmness, tempoaray unevenness, and delayed results may occur.

    Exact contouring, symmetry, or aestehtic outcome cannot be guaranteed.

     

    10. Touch-Ups and Additional Sessions

    I understand that optimal results may require additional sessions or adjustments, which may incur additional cost.

     

    11. Client Conduct and Professional Boundaries

    I agree to treat all staff respectfully.

    Elara Med Spa & Laser reserves the right to refuse or discontinue treatments due to unsafe, inappropriate, aggressive or noncompliant behavior.

     

     12. No Unauthorized Recording

    I agree not to audio or video record staff or treatments without written permission.

     

    13. Photography and Documentation

    I understand that photos may be taken for treatment tracking and documentation, and may be used to legally protect the business if needed.

    A separate consent is required for marketing use.

     

     14. Social Media and Defamation Policy

    I agree to bring any concerns directly to management for resolution.

    I agree not to post defamatory, misleading, or harmful content about the business or staff.

    I understand that false or damaging public statements may result in legal action.

     

     15. Refunds, Payments, and Chargebacks

    I understand that:

    • Completed services are non-refundable.

    • Promotions, packages, and memberships are non-transferable.

    • Chargebacks for completed services are not permitted.

    • Fradulent or unjustified chargebacks may be disputed using signed documentation and treatment records.

    • The clinic may submit documentation to financial institutions if necessary.

     

     16. Cancellations, Rescheduling, and No-Shows 

    • A minimum of 12 hours’ notice is required to cancel or reschedule.

    • One reschedule is permitted. Additional changes require prepayment.

    • No-show clients or repeated late cancellations may require prepayment before furture bookings. 

     

    17. Minors

    Clients under 18 must be accompanied by a parent or legal guardian.

    A parent or guardian must provide written consent.

     

     18. Consent to Communication 

    I consent to being contacted by phone, SMS, WhatsApp, or email for reminders, follow-ups, or administrative purposes.

    I understand communication through phone, email, SMS, or WhatsApp may not always be fully secure.

      

    19. Business Right to Modify Policies 

    I understand that Elara Med Spa & Laser, its owners, management, and legal advisors may update or modify policies, procedures, pricing, or terms at any time at its discretion.

    Booking or receiving services after updates indicates acceptance of the revised terms.

      



  • I confirm that I have read, understood, and agree to all of the above Terms & Conditions. I have had the opportunity to ask questions and all of my concerns were addressed. I voluntarily consent to receive aesthetic treatment(s) from Elara Med Spa & Laser and accept full responsibility for following all professional instructions.

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