Facial Treatment Consent Form

Facial Treatment Consent Form

The Babe Cave Beauty Bar
Date

MonthDayYear
Date
Date of Birth

MonthDayYear
Date
Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about us?
If referred, by who?
Your Medical History
Are you currently under the care of a physician?
Have you experiences any of these health conditions in the past or present?

Other
Any known allergies?

Other
If 'other' , 'fragrance' or 'food' was selected above please list any specific known allergies:
List medications/supplements you are currently taking:
Have you ever received any botox or fillers? if so, where and when?
Have you ever experienced claustrophobia?
Please rate your stress level.
What do you do for a living?
Your Skin
What would you say your skin type is?
What are your skin concerns?
Do you have any known skin conditions? (Ex: dermatitis, vitiligo)
What skin care products do you use on a daily basis?
What skincare brand?
Do you experience routine breakouts or acne?
Have you ever been diagnosed with eczema, psoriasis or rosacea?
Have you received any of these facial hair removal services in the last 7 days?
Do you currently use:
Please specify which product or type, if you answered YES to the question above.
Are you currently using any products that contain:
Have you ever received chemical peels, laser services, or microdermabrasion treatments?
Do you?
How often are you outside or in the sun?
Females Clients
Are you taking birth control?
Are you pregnant or breast-feeding?
I acknowledge that I should follow proper aftercare instructions from any services provided at The Babe Cave Beauty Bar.

It is client's responsibility to notify the service provider of any updates to answers provided on this form. It is essential to notify your service provider of any new medications, skin treatments provided outside of The Babe Cave Beauty Bar, and any new allergies.

Please do not exfoliate or use active ingredients including serums and toners for 36 hours before AND prior to your service at The Babe Cave Beauty Bar.
I acknowledge that my skin might experience temporary irritation, tightness, redness or slight swelling which usually dissipates within 72 hours depending on skin sensitivity.

I acknowledge that if I am allergic to one or more ingredients in the products used, I may experience allergic reactions.

I acknowledge that if I fail to use a minimal sunscreen (SPF45), I am more susceptible to sunburn, skin damage & hyperpigmentation. I should avoid excessive sun exposure especially between 10am-2pm.

I acknowledge that this treatment is strictly elective cosmetic procedure and no medical claims have been expressed or implied.

I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, waxing, and products containing acids that are no part of the recommended take-home regimen for 2-4 weeks following treatment.

I consent (to the best of my knowledge) that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment. I give consent for all future treatments

I release The Babe Cave Beauty Bar and its staff of any liability associated with any injuries and /or current and future conditions resulting from the skincare procedures or products.
Signature
Should be Empty:

Facial Treatment Consent Form

Your Medical History

Your Skin

Females Clients