Client Skin Consultation Survey

I consent to have my picture/video taken for marketing & social media purposes. If you would like an example, please check out my Instagram @Skinbyflynn*

I consent to picturesI consent to videos (all sound is muted, and music is played over)I consent to pictures but please blackout my eyes and hide my identityI do not consent-only allow internal photos for before & after requirements

Please tick (/) the answer below.

How/where did you find Skin By Flynn?

I consent to have my picture/video taken for marketing & social media purposes. If you would like an example, please check out my Instagram @Skinbyflynn*

YesNo

IMORTANT ACKNOWLEDGE ALL*

I have not been exposed to excessive sun and my skin does not feel sensitive or irritated in any way.I have not had any other chemical peel of any kind, within 14 days of this treatment.I have not had any facial waxing, within seven days of this treatment.I have informed the clinic of all health problems of which I am aware, including herpes simplex/cold sores.I have informed the clinic of any use of oral or topical medications including Retinoids, (Retin-A, Renova, Avita, Differin, Tazorac) or Accutane.Controlling acne/problem skin is best achieved through a series of treatments and compliance to the regimented home care products.If I follow my homecare instructions carefully, I will probably not experience much visible peeling, flaking, discoloration or irritation.

Prior to obtaining the services of Skin By Flynn: Molly Flynn, Licensed Esthetician, I certify that I clearly understand the following:

WARNINGS

Avoid direct sunlight or tanning booths for at least three days following a treatment.

Use of sunblock protection of at least a SPF 30 is necessary following all treatments.

Do not pick your skin following a treatment.

I choose to consult with Skin By Flynn as a Licensed Esthetician who conveys skincare information that people can use to enhance skin health. I affirm my right to self-health, and I take full responsibility for my healing process with her guidance and support.

I state that I come to Skin By Flynn, Licensed Esthetician, Molly Flynn with the purest of heart and purpose of seeking information. I state that I do not come with any forethought or will have any afterthought to entrap parties of Skin By Flynn into an illegal statement or action. I understand that Skin By Flynn's sole intention is to offer educational information that will help to bring improvement for my skin.

If I choose to use this information for myself or loved ones, then I affirm that the responsibility is mine. I understand that Skin By Flynn does not provide legal medical services, but instead suggestions that I can choose to use for skin healing.

Please read and sign to acknowledge that you understand and agree to the above statements. You will not be seen without it.

Thank you!

Acknowledgement of Cancellation/No Show Policy*

I acknowledge that I must adhere to the policies. I understand that cancellations must be done with at least 24 hours notice Failure to do so will result in the loss of a package or 50% of the total service cost. I acknowledge that ANY no show will result in the loss of a package or 100% of the total service cost. I understand that after 15 minutes of tardiness my appointment may be subject to cancellation and I will be responsible in accordance with the “No-show” policy

Refunds*

I acknowledge no refunds will be given. All services are cosmetic/luxury services and may require additional treatments for skin rejuvenation. Clients are responsible for researching their artist, portfolio, aftercare, risks, etc. All sales on services and products are final.

TERMS AND CONDITIONS I hereby agree to all of the above and agree to have this treatment be performed on me. I further agree to follow all post-treatment care instructions as I am directed.*

YES

e-Signature*

First NameLast Name

Name of Guardian

First NameLast Name

Relationship to Client

Signature of Guardian:

Date*

MonthDayYear

Acne Bootcamp Consultation

Section to be completed for Women only:

Guardians