• CONSULTATION FORM

    REQUIRED FOR EVERY APPOINTMENT

  • Appointment Location:

    1101 N Wilmot Rd Suite 121 Tucson AZ (until August 27th 2025)
  • Format: (000) 000-0000.

  • REQUIRED QUESTIONS FOR EVERYONE:

  • What service/s are you getting today?
  • EVERYONE Please mark any that apply:*
    • *CLICK HERE* IF CONSENT FOR MINOR 
    • Approve all to move forward.
    • *CLICK HERE* IF RECEIVING EYELASH LIFT/TINT & BROW LAM/TINT SERVICES 
    • Please mark any that apply:
    • *CLICK HERE* IF RECEIVING A PREGNANCY SAFE SERVICE 
    • Please mark any that apply:
    • *CLICK HERE* IF RECEIVING MICRONEEDLING  

    • The following are all contradictions that will prevent me from receiving treatment. 

      • Infected skin disorder, open cuts, wounds, or abrasions. 
      • Cardiovascular disease, must receive written permission from PCP.
      • Extreme anxiety issues, epileptic, pregnant, sunburned, untreated sinusitis, numb areas without sensitivity. 
    • Please mark any of the following that applies:

    • Aftercare:

      CLEAN:

      Use a very gentle cleanser and lukewarm water to rinse the face over the next 72 hours. Gently dry the treated area after rinsing and make sure your hands are as clean as possible. It is recommended that you do not use powered cleansing brushes for at least seven days after Microneedling.

      HYDRATE:

      The treated area of your skin may appear much drier than normal after the treatment, which is why it is recommended to use hyaluronic acid as it is excellent for hydrating and restoring your skin's balance.

      HEAL:

      It is suggested you use an antioxidant serum, these possess properties that are extremely effective when it comes to soothing the skin and reducing irritation, thus helping it heal faster.

      SUN PROTECTION:

      It's very important to apply chemical-free sunscreen to your skin after the treatment and keep using it everyday. 365 days a year!!

      NO MAKEUP:

      Avoid applying makeup for up to 48 hours after the procedure.

      TIPS:

      Avoid using any kind of powered cleansing brushes during the following week.

      Avoid sun for 72 hours plus post-treatment.

      Tanning beds as well. NO NO!

      No swimming for up to 72 hours.

      Make sure you do not work out for the first 48hours minimum after the treatment as sweating can lead to adverse reactions in the treated areas of your skin.

    • *CLICK HERE* IF RECEIVING HIGH FREQUENCY - IN THE ANTI AGING FACIAL & MENS FACIAL 
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  • Please inform me if you’d like to add on other services ahead of time to ensure I block enough time.

  • AGREEMENT:

  • I understand the contents of this form and take full responsibility for my actions, thus absolving all other parties of their responsibilities associated with the supply of the products and services(s). I hereby waive, release and forever discharge Self-Care Esthetics by Carissa and affiliated entities / representatives from any responsibility or liability.

  • Cancellation/Reschedule Policy: A 48-hour notice is required for rescheduling or canceling appointments. If canceled or rescheduled with less than 48 hours’ notice, 50% of the appointment price will be charged.

    Please reschedule if you or a family member has a fever or presenting an illness.

  • Late Policy: Your treatment STARTS at the time of your appointment. Please arrive a few minutes ahead of time to prepare yourself. Kindly notify Carissa at 520-261-6963 as soon as possible if you’re running late via text. I acknowledge that I have read and understood.

  • (I accept cash, Zelle, Venmo, and other digital payments. I also accept card payment with up to a 3 percent credit card processing fee that’s automatic. Cash is preferred please.)

  • P.S. Prices increase January 1st. Lock in your current pricing by pre-booking your appointments.
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