Dermaplaning Facial Form

Name

First NameLast Name

Date of Birth

Date

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Best way to contact you?

Occupation

How did you hear about Karina’s Beauty Spa?

Have you ever had a dermaplaning facial preformed by a professional?

If YES, when was the last time you had a dermaplaning facial?

In the last 48 hours, have you had a peel, microdermabrasion, or tanned?

What would you say your skin type is?

Have you ever had a facial or skincare treatment before?

If yes, when was your most recent treatment?

What type of facial did you last received?

What skincare products do you use on a daily basis?

Are you sunburned on your face right now?

Do you have any allergies?

Other

Please list all your allergies/allergens.

I understand the possible side effects include but are not limited to: skin tightness, mild to moderate redness, mild flaking, possible nicks

I understand this procedure removes most, not all vellus hair (peach fuzz)

I understand the results of this treatment may vary due to conditions such as age, condition of skin, sun damage, climate, etc.

I understand that direct sun exposure, including tanning beds, is not recommended while undergoing treatment and the use of a daily sun block protection is mandatory

I understand that any facial injections should be avoided 10 days before this treatment. I am not using Retin A, and have been off Retin A for at least 3 days prior to treatment. I will call my practitioner if I have any questions or concerns about my treatment

I have been advised not to exercise after my treatment.

I understand, To cancel an appointment you must cancel BEFORE 24 hours. my booking site will send you emails, scroll to the bottom and hit manage my appointments from there you will be able to cancel your appointment. If it's after the 24 hour mark it's not going to let you and I will charge you a 50% cancellation fee for any cancellation done after 24 hours. Cancellation and “No Show” fees will be charged to the credit card on file. Once this charge is completed, you may then schedule a new appointment. If the card declines, a hold will be put on your profile in our system. ALL FEES must be paid before booking a new appointment. By having a card on file and reading and understanding the policy, you are giving Karina’s Beauty Spa PERMISSION to charge your card in the event of a late, cancellation, and/or a no-show.

Karina’s Beauty Spa has a 10 minute GRACE PERIOD, If you are more than 10 minutes late there's a high possibility of your appointment being canceled. It's not fair for the rest of my clients who are on time. There will be charge of 50% of the service you booked. If you are more than 10 minutes late without no notice it will be considered a no call no show and you will be banned from booking in the future. I don't tolerate no call no shows, I'm very easy to communicate with. (Don’t hesitate to reach out, send me a text at 571-343-9903)

Please no extra guest unless if you are bringing a guest that's also getting a service

I Understamd NO REFUNDS. All purchases are FINAL SALE.

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 if I fail to use a minimal sunscreen (SPF45), I am more susceptible to sunburn, skin damage & hyperpigmentation. I should avoid excessive sun exposure especially between 10am-2pm.

I acknowledge that this treatment is strictly elective cosmetic procedure and no medical claims have been expressed or implied.

I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, waxing, and products containing acids that are no part of the recommended take-home regimen for 2-4 weeks following treatment.

I consent (to the best of my knowledge) that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment. I give consent for all future treatments

I release Karina's Beauty Spa and its staff of any liability associated with any injuries and /or current and future conditions resulting from the skincare procedures or products.

Signature

Date