• Kouture Beauty Bar Intake Form

    All information is held confident. At no given point is information disclosed or shared without client’s written consent. Client MUST complete this form or they will not be serviced.
    Kouture Beauty Bar Intake Form
  • Date*
     - -
  • Format: (000) 000-0000.

  • Emergency Contact

    Please list a trusted individual that I can get in contact with, if needed.
  • Format: (000) 000-0000.

  • Health Information

  • Do you have a history of cold sores or herpes simplex virus (HSV)?*
  • Are you pregnant?*
  • Are you using any hormonal medicine?*
  • Do you have sensitive skin?*
  • Customize your appointment (:*

  • For Facial Clients Only

    This section is for facial clients, if you are not getting a facial, please proceed to the next section.
  • Is this your first facial?
  • Is this your first facial with me?
  • Have you noticed any changes in your skin recently?
  • How Would You Describe Your Skin? (select all that apply)
  • What are your current skin concerns?

  • For Waxing Services Only

    If you are not getting waxes services, please proceed
  • Have you been waxed before?
  • Have you been waxed by me before?
  • Have you exfoliated within the last 48 hours?
  • Have you had an allergic reaction to waxing before?
  • Do you have any existing skin conditions or concerns in the area to be waxed? (e.g., eczema, psoriasis, rashes, open cuts, acne, sunburn, etc.)
  • Are you ingrown hair prone?
  • Are you using any of the following on your skin or taking any medications?
  • How would you describe your pain tolerance?

  • For Makeup Clients Only

    If you are not getting makeup services, please proceed to the next section.
  • Have you gotten your make up done before?
  • Have you gotten your make up done before by me?
  • Will your skin be clear of any dirt, debris, etc? (Reminder your skin must be clean)
  • Have you sent your ideal look 48 hours before your appointment?

  • All policies are posted on my instagram @theekouturebeautybar. It is soley up to the client to read these policies prior to signing this form. 

    Client information are confidential and written authorization is required to release any information.

    You will be draped and at no time be exposed

    You may end the session at any time for any reason


    Client Agreement:

    I understand that these treatments are not going to diagnose and heal illness, disease, any physical or mental disorder.

    I acknowledge that I have read over all business policies. 

    I understand that the services I receive are performed by a trained professional, but there are inherant risks asscoiated with any beauty treatment. 

    I understand that at any time I feel pain or discomfort during the session, I will immediately inform my service provider. 

    I have stated my pertinent medical conditions, and will update the service provider of any changes in my health status.

    I release my service provider from any liability for injuries, allergic reactions, or any other adverse effects resulting from the services provided. 

    By my electronic signature below, I agree to the massage policy and client agreement above. 

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