New Client & Consultation Form

Name

First NameLast Name

Date of Birth

Date

Phone Number

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

Address

Street Address

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CityState / Province

Postal / Zip Code

Reason for visit (any specific concerns)

List any allergies

*Please read the following statements carefully and indicate your understanding and acceptance by signing below, electronically.   

A. CANCELLATION POLICY 

We require a non refundable deposit of 20% of the service chosen, it will be applied to the final payment. A 24 hour advance notice is required in order to cancel or reschedule any service with no charge. If your appointment is not cancelled within this notification period, your appointment is considered confirmed. Any appointment cancelled, or changed without 24 hour notice will result in a charge equal to 20% of the reserved service amount (the deposit). We understand that certain circumstances may prevent you from being able to make your appointment and will do our best to work with you in that situation. 

B. LIABILITY

I will let my Esthetician, NATALY VERA, know if anything changes between appointments that could affect my service, (such as new medications, new topical creams & exfoliation, surgeries, botox/fillers, etc.).
I will follow all written and oral aftercare instructions given by my Esthetician, NATALY VERA, to ensure I obtain the best results on each service I receive.

C. WAIVER, RELEASE, ASSUMPTION OF RISK 

While Illuminous Beauty takes reasonable precautions to minimize the likelihood of any personal injury resulting from the provision of skincare treatment services, there is inherent risk involved in the delivery and receipt of skincare treatment services, which risk cannot be completely eliminated. By signing below, I acknowledge the existence of this risk, and I agree to accept and assume this risk. I further acknowledge that it is my responsibility to ask questions about the services, to disclose all known allergies and medical conditions to the service provider, and to make an informed decision regarding the receipt of services, all prior to receipt of any services.

 TO THE MAXIMUM EXTENT ALLOWABLE BY LAW, I HEREBY WAIVE MY RIGHT TO PURSUE ANY CLAIM, ACTION, OR DEMAND AGAINST ILLUMINOUS BEAUTY, RELATING IN ANY MANNER TO THE RECEIPT OF SKINCARE TREATMENT SERVICES. I FURTHER RELEASE ILLUMINOUS BEAUTY FROM ANY AND ALL LIABILITY FOR CLAIMS RELATING TO MY RECEIPT OF SKINCARE TREATMENT SERVICES. THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, LOSSES WHICH MAY OCCUR AS A RESULT OF: ALLERGIC REACTIONS; SKIN IRRITATION OR DRYNESS; POST-TREATMENT AILMENTS; AND EQUIPMENT MALFUNCTION.  

* By signing below, I agree to the cancellation policy and waiver/release described above. I am aware there are no refunds on any service or product. I agree that this document constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation from treatments received. (If client is under 18 years old, parent/guardian must sign below.)

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