Pure Beaute Retreat

Pure Beaute Retreat
Welcome to Pure Beaute

It’s our pleasure to pamper you. To ensure a safe and enjoyable experience, please complete this form in full before your appointment.
Name

First NameLast Name
Date of Birth
Phone number
Phone number
Email
example@example.com
Emergency Contact (Name & Number)
Identification Verification
For your safety and the safety of our staff, please take a photo of your non expired license or ID. Please don’t block out your information.

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Important: If you feel uncomfortable with uploading your ID, please take a picture yourself. Once we review and see your picture, you will be required to pay exact cash after your appointment. No exceptions.
Health & Medical History
Are you currently taking any medications or supplements?

YesNo
Are you using any tropical treatments? (Ex. Retin-A, Retinol)

YesNo
Do you have any allergies?

YesNo
Have you had any surgeries in the past 5 years?

YesNo
Are you currently pregnant?

YesNo
How would you describe you skin type? (Oily , Dry, etc)
Have you ever experienced any of the following? (Check all that apply)

AsthmaDiabetesEpilepsy/SeizuresHigh Blood PressureSkin Condition (Eczema etcCold Sores/HerpesEye InfectionsOther
Personal Consultation
Are you actively in the Gym or Sports?

YesNo
Are you frequently exposed to the sun?

YesNo
Do you use sunscreen?

YesNo
If booking a lash or nail service, upload your inspiration photo (optional)

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Client Consent & Agreement
I understand and agree to the following:
• The services provided at Pure Beaute’ are for beauty and wellness purposes only and are not a substitute for medical care.
• I acknowledge that results vary based on skin type, lifestyle, and adherence to aftercare.
• I understand that certain treatments may cause temporary redness, irritation, or other mild reactions.
• I will follow all post-care instructions to ensure the best results.
• I accept full responsibility for any allergic reactions or sensitivity due to undisclosed medical conditions, medications, or allergies.
• I release Pure Beaute’ and its staff from any liability related to my treatment and assume full responsibility for my skincare decisions.
By signing I Consent and agree that I have read and understood all the above statements

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Photos & Video Release
I consent to Pure Beaute using my before/after photos for marketing purposes.

Yes, I consentNo, I do not consent
Signature & Agreement
Signature

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Date

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Date
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Pure Beaute Retreat

Welcome to Pure Beaute

Identification Verification

Health & Medical History

Personal Consultation

Client Consent & Agreement

Photos & Video Release

Signature & Agreement