Spray Tan Intake and Consent

  • Client Questionnaire

  • Date of Birth
     - -
  • Format: (000) 000-0000.
  • Okay To E-Mail?
  • Okay to Call?
  • Okay to Text?
  • Format: (000) 000-0000.
  • Do we have permission to show your non-identifying photos for social media purposes?
  • How did you hear about Estie Co.?

  • Medical History & Intake

  • Have you received a spray tan or applied sunless tanner before?
  • Do you have any allergies to foods, skin care ingredients, or medications?
  • Any allergies related to Dihydroxyacetone (DHA)?
  • Do you wax your skin on a regular basis?

  • Please wax at least 48 hours prior to receiving a spray tan.

  • Do you have any skin conditions?
  • Do you have any respiratory illnesses?
  • Are you or could you be pregnant?
  • If yes, do you have permission to tan?
  • Are you under a doctor's care presently?

  • I have read and completed this questionnaire truthfully. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. The treatments I receive are voluntary and I release the company (Estie Co. LLC)  and/or skin care professional from liability.

  • Date
     / /

  • Informed Consent

  • Please read and sign that you understand the following: 


    DHA is listed in the Food, Drug and Cosmetic Act (FD&C Act) as a color additive for use in imparting color to the human body. However, its use in cosmetics – including sunless “tanning” products – is restricted to external application. According to CFR, “externally applied” cosmetics are those “applied only to external parts of the body and not to the lips or any body surface covered by mucous membrane” (21 CFR 70.3v).  

    • DHA reacts with the skin’s amino acids resulting in a “tan” similar to that of the sun. The darker you can tan naturally, the darker you can tan with a spray tan. Like most cosmetics, avoid exposure to the eyes, lips, and other parts of the body covered with a mucous membrane. This should be accomplished by following the staff’s breathing instructions as to avoid inhaling or ingesting the sunless product. 
    • Your spray tan should last 5-10 days, depending on your skin type and how well you take care of your sunless tan. It’s very important to keep your skin moisturized after your spray tan, avoiding long baths or showers and hot tubs. Salt water exposure or a chlorinated pool can also shorten your spray tan.  
    • Be advised there may be a small percentage of individuals whose skin does not react favorably to spray tanning, Some medications such as birth control pills, hormone replacement medications, or antibiotics may alter your tan. Please consult with your technician if you have any questions.
    • Estie Co. provides nose filters, hair nets, and Aquaphor for your lips at each session. Please initial whether you choose to use or not use these products.

  • I choose to use these products
    I choose NOT to use these products

  • Date
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  • Client Policies

  • Estie Co. will now require 24 hours notice for rescheduled and canceled appointments.
    There will be a 50% charge of service booked for last-minute (within 24 hours) cancellations or reschedules.

    100% of the service booked will be charged for no-call/no-shows. This will need to be paid before you are allowed to book another appointment. Refusal to pay will result in a ban from my schedule.

    If you are running 15+ minutes late for your appointment, there will be a 50% charge of the service booked and the appointment will need to be rescheduled.

    Sickness: Please, please do not come to your appointment if you are feeling sick AT ALL. Reschedule your appointment for a later date. This keeps everyone safe and allows Jules to continue working. There will be no exceptions for this, if you are sick, you will be sent home and charged 100% of the service.

    You can easily reschedule your appointment by going to the link that is sent to your email when you book. We know that last-minute things pop up so please make sure you reach out when canceling/rescheduling.

  • By signing below, I am agreeing to the policies stated above and agree to pay any penalties that may be charged by Estie Co. LLC in accordance to these policies.

  • COVID-19 Information & Liability Waiver

  • 1. Have you had a fever in the last 24 hours of 100°F or above?
  • 2. Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath?
  • 3. Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus type symptoms?

  • COVID-19 is a highly contagious virus that spreads from person to person. In addition to long-held and explicit sanitation measures this business has always adhered to, new preventative measures have been put in place to further reduce the spread of this novel coronavirus. However, these best practices still offer no guarantee regarding your potential risk of being infected. 


    Consent for Treatment 

    I understand that, because esthetics involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner/business from any claims related thereto. I give my consent to receive treatment from this practitioner.

  • Date
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  • Should be Empty: