Facial consent

Name*

First NameLast Name

Appointment date *

Date

Emergency contact phone number *

Please enter a valid phone number.Format: (000) 000-0000.

Emergency contact name *

First NameLast Name

Relationship to emergency contact *

Do you use retinol or tretinoin regularly? If so, please refrain from using strong actives for 48-72 hours before & after your facial*

Do you have any allergies? If so, please list*

Are you sensitive to ingredients in skin care? If so, please explain to what and the reaction

Do you have any areas of concern for your esthetician during your massage or in general? Neck, shoulders, hands, scalp etc. Full facials include a declotte, scalp, face, hand, arm and upper back massage, potential of hot stones/ice globes as well as some stretching to these areas mentioned. Depending on add ons may include cupping and or qua sha/lymphatic drainage etc. *

Would you prefer your esthetician to be chatty or quiet? Please note the esthetician will always ask some questions at the start of your appt. Especially if this is your first time with the esthetician. *

Are you sensitive to smells like essential oils?*

Do you have any skin concerns?*

Are you pregnant?*

What would you like to accomplish in this appt? Ex: relaxation, hydration, a new skin routine etc*

Do you want extractions? (Popping any form of acne. Ex: black heads & whiteheads.)*

Do you prefer hot stones or cold globes on your face?*

Are you ok with us potentially getting oil in your hair? We go directly from face massage to Scalp massage & may have reminence of oil*

Is there anything you would like to add on to your facial appt (if time allows & your Aesthetician is certified) please note these are extra cost unless your facial states it is included

Do you prefer your Esthetician to wear gloves during your service?*

We ask for your hair to be in a lose bun or down (easy access for scalp massage) Feel free to keep your jewlery to a minimum as we ask for necklaces, bracelets, rings and big earrings (studs are ok) to come off for the massage portion. We do have a jewlery Holder to store your jewlery in, if needed.

By signing below I understand my esthetician will take every precaution to ensure my safety as well as trying to prevent any adverse reactions. I understand reactions can occur with any ingredient/exfoliant and do not find Knockout Beauty Bar/ knockout lashes & skin, the owners & estheticians liable for any adverse reactions and understand there are no refunds on services rendered.

If you do have any reactions we would like you to reach out with pictures.

Signature

Facial consent form