Brushtan Client Consultation/Consent Form

Name

First NameLast Name

Date

Phone Number

Area CodePhone Number

Email

example@example.com

May we have your Instagram handle to connect on social media?

Example: @brushtans

Have you ever had a professionally applied Spray Tan?

YesNo

If yes please describe your experience:

Have you used at home self tanning products before?

YesNo

Have you had a patch test? **Recommended for pregnant women or those with sensitive skin

YesNo

If you have not patch tested, 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? If Yes, please explain

Do you suffer with any respiratory problems?

YesNo

Are you pregnant or breastfeeding?

YesNo

Do you have any skin or pigmentation conditions or disorders?

YesNo

If yes please specify:

Is your skin hypersensitive?

YesNo

Have you any known skin allergies?

YesNo

If yes please specify:

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

Will you arrive for your appointment wearing (or bring to change into) loose, dark clothing with no tight elastics as well as shoes that will not take off your fresh tan (such as sneakers, etc.)

YesNo

Is the tan for a special occasion?

YesNo

If so, can you share what is the special occasion and when is the date?

What kind of tan result would you like to achieve? (e.g. light and natural/ as dark as possible for my skin tone, etc.)

Would you consider yourself very fair, fair, fair-medium, medium-dark or dark skinned?

Would you be willing to allow before and after pictures of your tan? (No face shown without consent and no nudity) as well as after pictures of your developed tan (and you looking amazing in it!) for us to use to help our business grow? If yes, can you kindly write your consent or certain preferences below?

Any questions before your appointment?

Please read the following carefully and sign below.

There are a small percentage of people whose skin does not react favorably to spray tanning. For this reason, we do NOT advise being sprayed for the first time when your appearance is important; e.g., weddings, any special occasion, photographic sessions, modeling assignments, etc. unless you have had a trial spray tan with us prior.

An airbrush tan will not protect your skin from burning in the natural sun or in a UV tanning bed. Healthy, hydrated skin will hold results longer. Wait until the PRESCRIBED time given to you after your spray tanning session before your first rinse. If you must sit or lie down during the time the bronzers are still on your skin, please use precautions to avoid transfer to leather or fabrics. A dark towel or sheet is idea to avoid staining. The bronzers are water soluble and will wash out of most fabrics but it is best to use caution.

All the ingredients in our spray tanning solutions have been safely used in cosmetics and nutritional products for decades and have been proven safe for the skin. If you had adverse effects utilizing self tanning products or moisturizers in the past, you may experience similar effects with a professional airbrush tan.

There are rare occasions where individuals may be allergic to one or more ingredients in the spray tan solution. Please discuss this with the technician before proceeding if you have any concerns over allergies to ingredients such as Aloe Vera, fragrances, natural botanical oils etc.

The FDA has approved DHA for topical use only and should be kept away from mucous membranes. the FDA recommends the use of nose filters, lip protection (balm), and protective undergarments which are all complimentary and are available upon request. A powerful extraction fan system is in place to extract as much overspray as possible during your service.

While your tan will be customized to your skin, results can and will vary by person, and by circumstances that may be outside of the control of your tanning technician. This may include: medical conditions, skin type, skin texture, and many possible external conditions not visible to the naked eye, etc.

The product being applied to your skin contains instant, cosmetic color agents. These bronzers are temporary and water soluble (similar to make-up) and will wash off during your first shower. Please note, a significant decrease or change in color may occur once the bronzers have been removed.

The main, active ingredient for sunless tanning products is a skin-safe, sugar derivative called DHA (Dihydroxyacetone) or in some cases, Erythrulose. This tanning agent is clear in color and may take up to 24 hours after application to fully develop.

For best results, follow the recommended rinse schedule given by your technician and do not apply topical products or cosmetics, engage in any physical activities causing perspiration, or come in contact with water or liquids while the tan is processing. First rinse should be with warm water only and no soap. Use firm circular motions with your hand while rinsing and be careful not to miss any parts of your body where the bronzer may stick, such as back and behind knees, etc.

Your spray tan will probably last at least between 4-7 days, and longer with proper after-care and depending on lifestyle and other factors. All residual "tan" which is essentially dead skin cells that have been darkened by the DHA must be removed prior to any future tanning sessions. We do NOT recommend spraying or self-tanning more than once every seven (7) consecutive days as it does not give your skin the time to shed entirely and can lead to blotchy skin.

Sunless tanning products do not contain sunscreen or U.V. protection against sunburn. Repeated exposure of unprotected skin to U.V. light may increase the risk of premature aging, skin cancer, and other harmful effects. Spray tanning with a sunburn is NOT recommended and can negatively impact your final results. Please inform your technician if you have had or are recovering from a sunburn in the past 30 days. Your technician has the right to refuse this service with an active sunburn.

Due to the variability and nature of this cosmetic service, and due to the fact that although detailed instructions are given for preparation and after care of the skin that is crucial to the results of sunless tanning, there are many variables out of the control of the spray tan technician, there are no refunds due to dissatisfaction.

I, the undersigned hereby agree to release Brushtan, LLC owners, spray technicians, contractors and manufacturers from any or all damages that I might incur due to the use of Brushtans, LLC Sunless Tanning’s services and products. I understand the risks involved, and use it at my own risk. I agree to hold Brushtans, LLC harmless of any and all medical complications that may arise. I have been advised to discontinue use if any reaction occurs.

I, the undersigned acknowledge that the results of airbrush tanning do vary and that no guarantees of specific results are offered or implied. By signing this waiver, Brushtans, LLC and their employees/contractors are not held liable for any injury to persons or property and hold them harmless from any liability involved in the use of the tanning process. I understand that the cancellation policy as well as the no refund policy as stated on the booking information I received prior to making an appointment.

I, the undersigned release and discharge Brushtans, LLC from all manners of actions, judgments, sums of money and demands whatsoever in law, in regards to spray tanning or sunless tanning products. I affirm that I have been advised of all the correct procedures and give my permission to proceed with the spray application. I have been advised to discontinue use if any reaction occurs. I am not allergic to any dyes, inks or cosmetics to my knowledge, and if I am I will discuss these concerns with my doctor and my spray technician before I receive a spray tan.

Disclaimer: I declare that I have read and understood and 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.

All information provided is confidential. We reserve the right to refuse service to anyone for any reason.

Signature

Brushtan Sunless Tanning