Facial Consent Form

Facial Consent Form

If you have previously filled this form out you do not need to submit another unless something in your medical history has changed.
Name*

First NameLast Name
Email*
example@example.com
Instagram handle*
You'll be added to Instagram close friends list that will include information posted for clients only
About Your Skin
Have you had a facial before?*

YESNO
If yes, when was your last facial?
What are your specific skincare concerns?*

Dry Flakey SkinBreakoutsBlackheadsAcne*Loss of FirmnessClogged PoresSkin TextureLarge PoresHyperpigmentation / Uneven Skin ToneRednessSkin SensitivityRosaceaOily SkinMiliaFine LinesWrinklesOther
*If you have acne: I understand Sonrisa Beauty Studio's facials will only help clear out congestion and some current blemishes. It will not prevent future congestion or blemishes. If you need help clearing acne we can put you on an acne regimen.*

I understandNot applicable
What would you say your skin type is?*

Normal (no visible blemishes, fine pores, smooth texture)Oily (enlarged pores, excessive oil)Dry (dull, visible lines and wrinkles, feels tight)Combination (oily and dry patches, oily t-zone, hormonal breakouts)Acne (cystic or nodules)Sensitive (reactive to fragrance, often irritated)
Give us an idea of what you typically use on your skin daily?*

CleanserSoap (Bar or Hand)TonerSerumMaskExfoliant (physical or chemical)Eye CreamMoisturizerSPFVitamin A derivative (retinol/retinoids)Tyrosinase Inhibitors (Skin lighteners)Other
Are you currently using any products that contain:*

AHA (glycolic acid, lactic acid, mandelic acid etc.)BHA (salicylic acid)Vitamin A derivative (retinol/retonids)Exfoliating scrubsPrescription TopicalsNone
Optional: Share your skincare routine

Browse Files
For a thorough consultation please upload a photo of your current skincare products Cancelof
Any other reasons for booking a facial appointment besides your concerns?

RelaxationSkincare educationCreate a skincare routineI was gifted a facial serviceOther
Your Medical History
Any known allergies?*

AsprinLatexFruitsShellfishLidocaneFragrance/Essential oilsTree NutsDairySunscreenPollenNoneHoney/BeeswaxOther
Sonrisa Beauty Studio uses products in our facials that may contain fruits, tree nuts, gluten and dairy or have been manufactured in a plant/facility with these ingredients.*

I understand and acknowledge this and have been made aware that there is a remote chance of an allergic or adverse reaction and I would like to proceed with the service and keep my upcoming and future appointments.
Have you ever been diagnosed with eczema, psoriasis or rosacea on the face?*

YESNO
Have you experienced any of these health conditions in the past or present?*

Hormone ImbalanceCancer/ Systemic diseaseHigh Blood PressureDiabetesHeart problemArthritisAuto-immune DisorderAsthmaEpliepsy/SeizuresCold soresHIV/AIDSLupusDepression/AnxietyHeadaches/ MigranesPacemakerNoneOther
Please list medications or supplements you are currently taking.
Are you taking Vitamin B7 / Biotin supplements?*

YESNO
Are you taking birth control?*

YESNONot applicable
Are you pregnant or breastfeeding?*

YESNONot applicable
Contraindications

If you answer YES to any of the following we might not be able to proceed with a facial service. I will contact you directly if necessary.
Do you currently have any rashes, sunburns, active cold sores, itching, broken skin, underlying redness etc. on your face?*

YESNO
Has it been less than 12 months since taking accutane or receiving cosmetic surgery, radiation, or chemotherapy?*

YESNO
Have you received chemical peels or microdermabrasion treatments in the last 28 days?*

YESNO
Have you had Botox, fillers, mirconeedling or nano infusion in the last 14 days?*

YESNO
Have you received a brow tattoo or removal in the last 14 days?*

YESNO
Have you used Retinol or Retinoids in the last 7 days?*

YESNO
Have you received any of the following facial hair removal services in the last 7 days?*

WaxingDermaplane / shavingSugaringThreadingLaser / ElectrolysisNone
Permission to Use Pictures
Do you allow Sonrisa Beauty Studio to film and photograph content to use for marketing purposes on social media accounts, marketing materials, websites, training manuals/ebooks/digital products etc?*

YESNO
Acknowledgement and Waiver

I hereby agree to have this treatment be performed on me. I am aware that products used in facials and homecare can contain fruits, tree nuts, dairy and gluten. I acknowledge that the estheticians at Sonrisa Beauty Studio may use products that contain these ingredients or are manufactured in a plant/facility with these ingredients. I am aware that even with natural ingredients there is a remote chance of an allergic reaction and there is a possibility of an adverse reaction to product used in facials. I request and consent to these services being carried out without undergoing a sensitivity patch test.

I am also aware that certain services should not be performed with certain medical conditions. I have disclosed all my known medical conditions, allergies, medications and answered all questions honestly on the above form and agree to update Sonrisa Beauty Studio as to any changes.

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 there may be unforeseen risks with Dermaplaning such as nicking, scraping or abrading the skin with the blade.

I acknowledge I am not using Retin A®, or other retinol derivatives, products containing Alpha Hydroxy Acids (AHA) or Beta Hydroxy Acids (BHA) and have been off these products at least 3 days prior to treatment.

I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, waxing, and products containing acids for at least 3-5 days following treatment.

I acknowledge that the estheticians and staff at Sonrisa Beauty Studio do not provide medical advice and I accept full responsibility to seek out such advice before receiving any services or products from Sonrisa Beauty Studio. I hereby release, discharge and waive any and all claims against Sonrisa Beauty Studio and each of their partners, employees, representatives or any person(s) performing services or applying any products at Sonrisa Beauty Studio, including from liability and responsibility for any and all illnesses, allergies, injuries, damages, claims, rights and causes of action of any kind or nature, that may occur during or arising out of any services or products received on this and any future dates. I expressly assume and accept the risk for any injuries sustained. I have read this entire document and agree to its terms.

I have read, understood and agree to all of the above and consent to the service that I am scheduling an appointment for.
Please sign below by typing your First and Last Name *
Prepare for your appointment + Aftercare instructions can be found using the link below.

View Prepare for your Appointment + Aftercare Instructions
Should be Empty:

Facial Consent Form

About Your Skin

Your Medical History

Contraindications

Permission to Use Pictures