Cient Intake Form

BABEOLOGY WAX & BEAUTY STUDIO
Client Information and Consent
Name*
Age*
DOB*
Occupation*
Address
Phone*
Skin Type & Concerns

Please Check all that apply
Acne*

YesNo
Oily*

YesNo
Dry*

YesNo
Aging*

YesNo
Pigmentation*

YesNo
Texture*

YesNo
Sensitive*

YesNo
Blackheads*

YesNo
Whiteheads*

YesNo
Sunburn*

YesNo
Other
What skincare products are you currently using?*
Do you have allergies*

YesNo
List allergies (NA if none)*
CURRENT SKIN CARE ROUTINE. CHECK ALL THAT APPLY
Cleanse*

YesNo
Exfoliate*

YesNo
Tone*

YesNo
Serum*

YesNo
Eye Cream or Gel*

YesNo
Moisturize*

YesNo
Client Information and Consent
DO YOU CURRENTLY HAVE OR HAVE EVER BEEN TREATED FOR ANY OF THE FOLLOWING?
Hypertension*

YesNo
Diabetes*

YesNo
HIV*

YesNo
Cancer*

YesNo
Skin Disease*

YesNo
Herpes Simplex*

YesNo
Hormone Therapy*

YesNo
Other
Do you have any metal implants in your body?
Do you have any metal implants in your body?*

YesNo
List where
Are you pregnant or breastfeeding?
Are you pregnant or breastfeeding?*

YesNo
How did you find us?*
By signing below, you agree to the following:

I have completed this form to the best of my ability and knowledge and agree to inform my esthetician of any changes to the information listed on all the pages of this client intake form. I agree to receive the service(s) booked. I have been informed of and understand the contraindications to the requested treatments and agree that I do not have any condition(s) that would make the requested treatment unsuitable. I will inform my esthetician of any discomfort I may experience at any time during my treatment to allow them to adjust accordingly. I agree to waive all liabilities toward my esthetician and "Babeology" for any injury or damages incurred due to my misrepresentation of my health history.
Signature*

Clear
Date*

MonthDayYear
Date
Photo & Media Consent
Acknowledgement & Authorization of photo & or video

NOT REQUIRED- I grant "Babeology permission to take photographs, videos, or other media for use of comparing treatment results in marketing, advertising, social media, website, newsletters, magazines, recruiting brochures, emails, books, and general publications.

I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image.
Please initial below
I am at least 18 years of age and am competent to contract in my own name. I have read this release before signing below, and fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.*
IMAGES AND VIDEOS TAKEN DURING SERVICES AT BABEOLOGY WAX & BEAUTY STUDIO WILL ALWAYS BE HANDLED ETHICALLY AND CONFIDENTIALY. YOUR IDENTITY WILL ALWAYS REMAIN ANONOMOUS
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

BABEOLOGY WAX & BEAUTY STUDIO

Skin Type & Concerns

DO YOU CURRENTLY HAVE OR HAVE EVER BEEN TREATED FOR ANY OF THE FOLLOWING?

Photo & Media Consent

Please initial below

IMAGES AND VIDEOS TAKEN DURING SERVICES AT BABEOLOGY WAX & BEAUTY STUDIO WILL ALWAYS BE HANDLED ETHICALLY AND CONFIDENTIALY. YOUR IDENTITY WILL ALWAYS REMAIN ANONOMOUS