Radiant Skin and Brows - Returning Esthetics form

Radiant Skin and Brows

Returning Client Intake and Consent Form
Name*

First NameLast Name
Contact info - if changed
What are the top 2-3 things you would like to focus on? (if changed)

Aging (fine lines/wrinkles)Stress reduction / relaxationAcne / breakoutsRedness / inflammationCongested pores (white/black heads)Dullness / drynessSun damage / hyperpigmentation / dark spotsExcessive oilinessOther
What skincare products do you use? (if changed)
Please list any changes to medical history including oral/topical medications, recent surgeries, new allergies, etc.
If receiving a facial, do you prefer a more quiet, relaxing service, or would you like me to explain what I'm doing and what products I'm applying?

I just want to relax!Give me all the education please!Quiet during the services, but explain after!No preference
Reminders and Policies:

Cancellations within less than 24 hours (or if you are over 20 min late) will be charged a fee of 50% of the service. No call/no show appointments will be charged 100% of the service.

I can accept cash, card, or venmo. Payment must be made before leaving your appointment. There are no refunds of services rendered or products purchased.

Please do not bring any children or guests who are not also receiving a service (unless you have spoken to me)

Please put cell phone on silent, so you can be present for the appointment, especially facials!!

For facials, please wear little to no makeup to your appointment. If you have much makeup on, removing your makeup will take time away from your skin treatment.

For any facial or waxing service, avoid use of any retinoid (tretinoin, retinol, adapalene, etc) for at least 3-5 days prior.
- I confirm that the answers I have given are correct to the best of my knowledge and I have not withheld any information that may be relevant to my treatment.

- I understand that there are no guarantees as to the result of this treatment, due to many variables such as age, conditions of the skin, sun damage, smoking and climate.

- I hereby consent to and authorize Rachel Farmer to perform the esthetic services I have voluntarily elected to undergo.
I have read and agree to the above policies and statements.*
Please Initial
While Radiant Skin and Brows takes reasonable precautions to minimize the likelihood of any personal injury resulting from the provision of esthetic treatment services, there is inherent risk involved in the delivery and receipt of skincare treatment services, which risk cannot be completely eliminated. By signing below, I acknowledge the existence of this risk, and I agree to accept and assume this risk. I further acknowledge that it is my responsibility to ask questions about the services, to disclose all known allergies and medical conditions to the service provider, and to make an informed decision regarding the receipt of services, all prior to receipt of any services.*

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