Spray Tanning Intake Form

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

I understand for optimal results, I must shave within 24 hours prior to spray tanning treatment, if applicable.*

YesNo

I understand for optimal results, I must exfoliate within 24 hours prior to the spray tanning treatment?*

YesNo

Have you had a patch test prior to the spray tanning treatment?*

YesNo

If not, please confirm you are happy to proceed with your treatment*

Yes, I am happy to proceedNo, I will reschedule

Have you had any surgery or medical treatment in the last 12 months?*

Do you suffer with any respiratory problems?*

YesNo

Are you pregnant or breastfeeding?*

YesNo

Do you have any skin or pigmentation disorders?*

YesNo

Is your skin hypersensitive?*

YesNo

Have you known any allergies?*

YesNo

Have you any open cuts/wounds/rashes?*

YesNo

Have you recently had any body piercings or tattoos?*

YesNo

Do you wear contact lenses?*

YesNo

Have you had any recent Botox or fillers?*

YesNo

I understand there are certain conditions that may be aggravated by receiving spray tanning treatments, including allergies, asthma, open wounds, pregnancy, and respiratory conditions, and I must consult a physician for permission before being spray tanned.*

YesNo

I understand that reactions are rare, but may include possible allergic reactions including itchiness, redness, rash, coughing, dizziness, fainting and/or other irritations.*

YesNo

I understand that spray tanning is accomplished by the application of a solution containing Dihydroxyacetone (DHA) which has been approved by the FDA for external use only.*

YesNo

I understand that it is my right to request nose plugs, protective eyewear and occlusive lip balm to protect my mucus membranes from DHA exposure before my treatment, per recommendations made by the FDA.*

YesNo

I understand that the spray tan does not contain a sunscreen and does not protect against sunburn.*

YesNo

I understand that it is imperative to my health that I disclose all of the information requested in the Client Profile/Health History.*

YesNo

I have cited all conditions and circumstances regarding my health history, medications being taken, and any past reactions to products or medications.*

YesNo

I understand it takes a minimum of 4-6 hours for the spray tanning solution (containing DHA) to react with the amino acids on the skin’s surface, and showering and sweating are not recommended during that time.*

YesNo

I understand the spray tan will last approximately 4-6 days, depending on my skin cell turnover rate and the condition of my skin before and after the spray tan treatment.*

YesNo

I understand that while the goal of this treatment is to give the skin an overall bronzed look, no specific guarantees of the result can or have been made.*

YesNo

I understand that if I am under the age of 18, I must wear undergarments during the treatment.*

YesNo

I understand that if I am under the age of 18, I must have parental consent to receive this treatment/service*

YesNo

Do you have bleached hair?*

YesNo

I understand that for optimal results, I must arrive without the use of deodorant, perfumes, moisturizer, or any oil-based products prior to the spray tanning treatment.*

YesNo

I understand that the spray tan solution can stain clothing and that dark-colored clothing is recommended.*

YesNo

Is the tan for a special occasion?*

YesNo

Have you had a spray tan or used tanning products before?*

YesNo

What was your experience?*

How well do you tan in the Sun?*

What shade of tan would you like to achieve? Light, Medium, Dark or Very Dark?*

I consent to “before and after” photographs for the purpose of documentation, potential advertising and promotional purposes.*

YesNo

Any questions?*

APPOINTMENTS

Retainer Payment: A 50% non-refundable retainer payment is required to secure all service appointments. This amount is credited towards your service on the day of your appointment.

Please remove all makeup PRIOR to your appointment.

Please arrive 10-15 minutes PRIOR to the start of your appointment to complete all consent forms. These forms are also available online and may be completed PRIOR to your appointment. (Please note that in the event your consent forms ARE NOT completed PRIOR to the start of your appointment, this may result in a shortened appointment time.

RESCHEDULING & APPOINTMENT CANCELLATIONS

Rescheduling: If you reschedule your appointment with less than 24 hours' notice, a new retainer will be required to secure the new appointment time. To cancel or reschedule, please contact us directly by email at info@blushartistrytx.com or by phone at (832)850-6138.

Cancellation Timeframe: If you need to reschedule or cancel your appointment, please do so at least 24 hours in advance of your appointment start time.

Late Cancellations: Cancellations made less than 24 hours from the scheduled appointment start time will result in the forfeiture of the 50% retainer payment. (This policy is in place because short-notice cancellations provide insufficient time to fill the vacated slot, thereby impacting our staff and other clients.)

LATE ARRIVAL

Notification of Late Arrival: If you anticipate being late, we kindly ask that you inform us as soon as possible. This allows us to adjust our schedule and advise you on the best course of action.

Grace Period: We understand that minor and unexpected delays can happen. A grace period of 15 minutes is allowed for all appointments. During this time, we will hold your appointment slot open for you, however, please note that the original appointment time may be shortened.

Arrival Beyond 15 Minutes: If you arrive more than 15 minutes after your scheduled appointment start time, your appointment will be considered canceled. In such cases, the following terms apply:
a. Forfeiture of Retainer: Your initial 50% retainer payment will be forfeited as it compensates our staff for their reserved time and the lost opportunity to serve other clients.
b. Rescheduling Your Appointment: To reschedule your missed appointment, a new 50% retainer payment will be required. This ensures the commitment to your new appointment time and availability of our services.
c. Appointment Shortening: Depending on our booking schedule, we may offer to shorten your service instead of canceling it if you arrive within the grace period. However, this is subject to availability and cannot be guaranteed.

NO SHOWS

No-Shows: Clients who fail to show up for their scheduled appointment without any prior notification will also forfeit the retainer payment. Repeated no-shows may result in refusal of future service.

Communication: To cancel or reschedule, please contact us directly by email at info@blushartistrytx.com or by phone at (832)850-6138.

Informed Consent/Release of Liability:

I declare that I have read, understood and have answered the questions to the best of my knowledge. I have no known medical conditions or allergies that may affect or induce a harmful reaction from a sunless tanning treatment.

The information above is for the company's/staff's records only and will not be misused or passed on to any other third-parties.

I have accurately answered the questions above, including all known allergies, prescription drugs, conditions, or products I am currently ingesting or using topically.

I am aware that every precaution will be taken by the company and staff to ensure my safety and well being before, during and after your spray tanning treatment, and I have been made aware of the possible risks.

I understand that if I have any concerns, I will address these with my skin care specialist.

I understand my skin care specialist will take every precaution to minimize or eliminate negative reactions as much as possible.

In the event I may have additional questions or concerns regarding my treatment, I will consult the skin care specialist immediately.

I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures.

I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered.

I understand the procedure and accept the risks. I do not hold the company or skin care specialist, responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.

I give permission to my skin care specialist to perform the spray tanning procedure we have discussed, and will hold him/her and his/her staff harmless and nameless from any liability that may result from this treatment.

I have read, fully understand and accept this Informed Consent/Release of Liability Form and agree to accept all of the provisions and certify that the information collected is true.

Signature

Date

Spray Tanning

POLICIES