Glow with the Floww Spray Tanning Consent Form

Name

First NameLast Name

Date of Birth

Date

Phone Number

Area CodePhone Number

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Have you had a patch test? **Recommended for pregnant women or those with sensitive skin

YesNo

If not please confirm you are happy to proceed with your treatment

Yes, I am happy to proceedNo, I will reschedule

Have you had any surgery or medical treatment in the last 12 months? If Yes, please explain

Do you suffer with any respiratory problems?

YesNo

Do you have any skin or pigmentation disorders?

YesNo

If “Yes” please specify what that skin or pigmentation disorder is

Are you pregnant or breastfeeding?

YesNo

If you are pregnant please confirm you are past your first trimester and have spoken to your doctor/midwife and have been given consent to proceed with spray tan

Is your skin hypersensitive?

YesNo

Have you any known allergies?

YesNo

If yes please specify:

Have you any open cuts/wounds/rashes?

YesNo

Have you recently had any body piercings or tattoos?

YesNo

If answered “Yes” please specify how long ago

Have you received and read the Prep steps to ensure you can achieve the best tan

YesNo

Acknowledge that all Aesthetic Services (waxing, nails, hair colour, eyelashes) are to be done at least 24 hours prior to your Spray Tan appointment

YesNo

Are you currently doing laser hair removal treatments

YesNo

If “Yes” please advice the last time you had this treatment

Have you had any recent Botox or fillers?

YesNo

If answered “Yes” please indicate when

24 hours prior to your appointment you will exfoliate

YesNo

Is the tan for a special occasion?

YesNo

Have you had a spray tan or used tanning products before?

YesNo

What was your experience?

What tan would you like to achieve?

How well do you tan in the Sun?

Have you recently been sunburned? If so how long ago? *note that it can take several weeks for a sunburn to heal if less than 6 weeks we cannot spray tan as it will make the appearance worse.

Any questions?

Disclaimer: I declare that I have read and understood and answered the questions to the best of my knowledge.

I have no known medical conditions or allergies that may affect or induce a harmful reaction from a sunless tanning treatment.

I acknowledge that if I choose not to follow the prep instructions provided for me that it can affect the outcome of my spray tan.

The information above is for the therapists records only and will not be misused or passed on to any other third-parties.

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Signature

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