Mojan Skin Care Esthetician Consent Form

Client Name*

First NameLast Name

Date of birth

Date

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please take a moment to answer the following questions

Are you presently taking any medications?

YesNo

Are you pregnant?

YesNo

Do you have any allergies to cosmetics, food or drug?

YesNo

Please specify

What skin care products do you currently use?

Please specify

Have you had skin cancer?

YesNo

Do you use acne medication?

YesNo

Are you taking oral contraceptives?

YesNo

Please check if you are affected by or have any of the following

I agree with

If I experience any pain or discomfort during the session, I will immediately inform the esthetician so that the products and/or technique may be adjusted to my level of comfort.

I further understand that facial should not be construed as a substitute for medical examination, diagnosis, or treatment.

I understand that estheticians are not qualified to perform, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such.

I agree to keep the esthetician updated as to any changes in my medical profile during the session and understand that there shall be no liability on the estheticians part should I fail to do so.

I understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session.

Also I understand that;

The services offered are not substitute for medical care, and any information provided by the therapist is for educational purposes only and not diagnostically prescriptive in future
**Appointments & Cancellations**
A credit card is required to reserve an appointment.

If you are unable to attend your appointment, please contact us immediately at 832-510-8480 or via email at mojanskincare@gmail.com. Please inform us at least 24 hours before your scheduled appointment if you wish to cancel. Failure to cancel or reschedule within this time frame will incur a 50% service charge.

Please arrive to your appointment at least 10 minutes in advance so that the necessary paperwork can be completed. Late arrival may result in reduced treatment time or cancellation of the appointment. At Mojan Skin Care, we will do our best to ensure that your appointment runs on time; however, should we need to cancel or postpone your appointment on short notice, we will make every effort to contact you in advance.

If you arrive late to your appointment, you will still be charged for the entirety of the service.

Prior to your appointment, we will inform you of any preparation required in advance of your treatment. Failure to follow the guidelines may result in cancellation of your appointment or reduced treatment time.

Package of treatments
All treatments purchased as a package must be paid in full prior to the first treatment. All treatment packages must be used within 12 months of the date of purchase. Any treatments left unused after 12 months will be forfeited.

Treatment suitability
We will always assess whether a treatment is suitable for you or if it will yield desired results, prior to any treatment being carried out. If not, we will inform you as to the reasons why. You will only be liable for the cost of the initial consultation when applicable.

Liability
Mojan Skin Care is not responsible for any lost or stolen goods on our premises.

It is the client's responsibility to ensure that he or she provides Mojan Skin Care with all relevant medical details prior to each treatment. Mojan Skin Care will not be liable for any damage that occurs as a result of the client’s failure to disclose such details.

The client agrees to comply with all instructions and/or recommendations given to them by, or on behalf of, Mojan Skin Care regarding the care of a treated area. Nothing in these terms of business shall exclude or limit Mojan Skin Care's liability for death or any personal injury resulting from Mojan Skin Care's negligence.

Your right to complain
Mojan Skin Care strives to treat all its clients appropriately, compassionately, and fairly. If, however, you have an issue in relation to your treatment and service provided by the employees of Mojan Skin Care, you are entitled to lodge a complaint, either verbally, by telephone, or in writing. We will endeavor to fix any concern raised by a client.

Return policy
No refunds and no returns. Products that have been used or opened cannot be accepted for return. Unopened products can be exchanged within 6-10 days of purchase.

**Privacy Policy**
Mojan Skin Care ("us", "we", or "our") operates the website (the "Service”). https://www.mojanskincare.com

This page informs you of our policies regarding the collection, use, and disclosure of personal data when you use our service and the choices you have associated with that data.

Client Signature*

Date*

Date