Facial Client Intake and Consent Form

Full Name

First NameLast Name

Date:

What is your age?

Birthday

Date

Contact Number

Format: (000) 000-0000.

Email Address

example@example.com

When’s the last time you had a facial?

Have you ever had a reaction to a facial service? If yes, please describe:

What’s your skin type: ( Dry, Oily, Normal, Acne)

What facial are you receiving today?

Are you pregnant?

Check the conditions that apply to you:

Are you currently using any of the following? Please list any that apply: Accutane, Glycolic Acid, Retin A, Birth Control? Or say NA if none apply to you.

Are you currently taking any medication?

Do you have any medication allergies?

What are your skin concerns?

What do you use on your skin? Any acids?

How did you find us?

What’s the occasion?! (Birthday, bride, vacation, just pampering myself, etc …)

Are you interested in purchasing skincare products?

I do/ do not grant permission for Viva La Beautyy to use photographs and video taken of me on the specified date in the specified location for marketing and publicity purposes. I understand photographs and videos may be used digitally, such as on social media or on the website, brochures, for marketing and publicity purposes! Please selected I do or I do not for the use of photographs or videos during the treatment.

Facial aftercare is essential to maintain the benefits of your facial treatment and to promote healthy, glowing skin. Here are some key aftercare guidelines to follow: 1. Avoid Touching Your Face - After a facial, avoid touching your face to prevent transferring bacteria or oils that could cause irritation or breakouts.2. No Makeup for 24 Hours - For at least 24 hours post-facial, refrain from applying makeup to allow your skin to breathe and recover.3. Hydrate Your Skin - Keep your skin hydrated by using a gentle moisturizer that suits your skin type. This helps lock in moisture and support the skin’s healing process.4. Avoid Sun Exposure - Avoid direct sun exposure for at least 48 hours. If you must go outside, apply a broad-spectrum sunscreen with SPF 30 or higher to protect your skin from UV damage.5. Do Not Use Harsh Exfoliants - Avoid using exfoliating products (scrubs, acids, etc.) for 3-5 days after the facial to prevent irritation.6. Skip Hot Showers or Steam Rooms - Avoid hot water, saunas, or steam rooms for at least 48 hours. Heat can irritate the skin, especially if your facial included extractions or chemical treatments.7. Avoid Heavy Exercise - Avoid strenuous exercise or activities that cause excessive sweating for 24-48 hours post-facial to prevent pore clogging.8. Sleep on Your Back - If possible, sleep on your back to avoid putting pressure on your face and causing irritation to freshly treated skin.9. Use Gentle Skin Care Products - Stick to a gentle, fragrance-free cleanser and avoid products with alcohol or harsh ingredients for a few days post-facial.10. Follow Your Esthetician’s Advice - If your facial included specific treatments like extractions, masks, or serums, your esthetician may provide additional personalized aftercare instructions. Make sure to follow these for the best results. Please write I agree.

This signature consents that you understand and confirms that….. I have elected by my own decision to have a facial done.I have read the above information and have given accurate answers to the questions.I give the Esthetician permission to perform the facial procedure.I understand that there are often inherent risks associated with skincare services and I agree that as a condition for providing this services, I hold this studio, Viva La Beautyy and Esthetician harmless from any problem that may result from this treatment.

Please Sign Below

Signature

Required Deposit for Service

USDMinimum Deposit

Payment Methods

Credit Card

Apple Pay