• Facial Consent Form

  • Date*
     - -
  • Date of Birth *
     - -
  • Format: (000) 000-0000.
  • How did you hear about us?*

  • Your Medical History

  • Are you currently under the care of a physician?*
  • Have you experiences any of these health conditions in the past or present?
  • Any known allergies?*
  • Have you ever experiences claustrophobia?
  • Please rate your stress level

  • Your Skin

  • What would you say your skin type is?
  • What skin care products do you use on a daily basis?*
  • Do you experience any breakouts or acne?
  • Have you been diagnosed with eczema, psoriasis or rosacea?
  • Have you received any of these facial hair removal services in the last 7 days?
  • Do you currently use:
  • Are you currently using any products that contain:
  • Have you ever received chemical peels, laser services, or microdermabrasion treatments?
  • Do you?

  • Females Clients

  • Are you taking birth control?
  • Are you pregnant or breast-feeding?
  • I grant BARE SKIN BEAUTY LOUNGE permission to take photographs, videos, or other media for use in marketing, advertising, social media, website, newsletters, magazines, recruiting brochures, emails, books, and general publications. I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and waive any right to royalties or other compensation arising from or related to the use of the image.

  • 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 am allergic to one or more ingredients in the products used, I may experience allergic reactions.

    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 Bare Skin Beauty Lounge and its staff of any liability associated with any injuries and /or current and future conditions resulting from the skincare procedures or products.

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