Body/Face Sculpting Consent Form

Client Name*

First NameLast Name

Parent/Guardian Name (if client is a minor)

First NameLast Name

Client Date of Birth

Date

Client Phone Number*

Please enter a valid phone number.

Client Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Client Email*

example@example.com

Upload a photo of your Photo ID/Driver's License/Passport

Appointment Date*

Date

Contraindications/Disqualifications

Pregnant
- Pregnancy is not a contraindication, but it is recommended for the client to obtain a doctor's note prior to treatment if they are pregnant, due to hormone changes within the body the results of self tanning treatment may differ
If nursing, it is recommended to avoid tanning the breast area
Contagious skin disorders (fungus, viralm bacterial)
Skin disorders (where the skin is broken, psoriasis, eczema, dermatitis, erythema where the skin is already sensitized (red)
Open cuts, abrasions or wounds (skin irritation and a secondary infection could occur where the skin is broken
Allergies to tanning products or specific ingredients used in tanning systems
Positive allergic reaction to a skin test
Respiratory conditions (existing conditions may be aggravated by spray products)
Sunburn (must be 4 weeks healed, spray tanning over sun burned skin will result in a patchy tan once you begin peeling)

Spray Tan Pre-Care Instructions

Failure to follow pre-care and aftercare instructions will result in an uneven and patchy tan result.

*For minors a parent or guardian is required to attend the entire spray tan appointment

4-5 Days Before Your Spray Tan

Use a natural, vegan, organic, paraben-free, sulfrate-free body wash/soap and body lotion to hydrate your skin
- Visit our website www.GlowBeauteSalon.com to order our spray tan safe pre-care/aftercare products for shipping or local pickup in Huntington Beach, CA
Drink plenty of water to keep your skin hydrated

24-48 Hours Before Your Spray Tan

Wax/shave any unwanted body hair
Exfoliate entire body with a kessa mitt (exfoliating glove/scrub/brush)
Avoid using any bar soaps or cream-based body washes
Ensure that all soap and body product residues are thoroughly washed off the skin
Complete any spa facial/massage/nail treatments

Day of Appointment

DO NOT APPLY any lotions, oils, deodorant, perfumes or makeup

Wear dark loose-fitting clothing with open-toed loose fitting sandals (Ex: Baggy shirt, sweatpants or maxi dress)

Spray Tan Aftercare Instructions

Hours After

Do not get wet or sweat until your initial rinse
Rinse in lukewarm water with no soap

2-12 Hours After

Avoid moisture until your initial rinse
Do not touch your body
Standard tans must rinse in 8-16 hours
Rapid tans must rinse in 4-12 hours
Rinse at your designated time

24 Hours

Moisturize morning & night
Avoid swimming, hot showers/baths, saunas, and excessive sweating
No exfoliating until the tan is at the end of its life

By signing the below I acknowledge that I have read the Pre-Care/Aftercare instructions and Contraindictions/Disqualification List.

Client Signature or Parent/Guardian (if client is a minor)*

Have you received a spray tan or applied sunless tanner before?*

YesNo

When was the last time you had a spray tan or applied sunless tanner (approximate date)?

Date

List any known allergies

Do you have any allergies to dihydroxyacetone (DHA)?*

YesNo

Do you have any skin conditions?*

YesNo

If yes, please list any skin conditions below

Do you have any respiratory illnesses?*

YesNo

Are you or could you be pregnant?*

YesNo

If you are pregnant, are you cleared by your doctor to spray tan?*

YesNo

Are you currently under a doctor's care?*

YesNo

If yes, please list any medical conditions you are under care for:

If there is a need to cancel for any reason, we ask for a 72-hour notice. Please understand that when you do not cancel or show up for an appointment, it is a cost to us. If you cannot provide us with a 72-hour notice, we may impose the following fees:

No Show for Session/Same day cancellation:
*100% service charge

I have read and understand the cancellation policy of the service provider and agree to abide by the above conditions.
Your Name*

Client Signature or Parent/Guardian (if client is a minor)*

Client/Parent or Guardian Signature Date*

Date

The following provisions apply to the services to be performed for
Your Name*.

1. Services to be Provided: The office provides airbrush spray tanning. (Initial Below)*