CLIENT CONSENT FORM

CONSULTATION FORM

FACIAL & SKINCARE
Name:

First NameLast Name
Date of Birth:

MonthDayYear
Date
Age:
Sex:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Email:
example@example.com
Emergency Contact & Number:
How did you hear about us?
Health & Medical History
Do you have any pre-existing medical conditions or chronic illnesses? Please describe.
If yes, please describe.
Are you currently taking any medications or supplements?
If yes, please describe.
Have you had any recent surgeries or medical procedures?
If yes, please describe.
Have you had any allergic reactions to medications or substances in the past?
If yes, please describe.
Do you have any known skin allergies or sensitivities?
If yes, please describe.
Facial & Skincare History
Have you had any previous treatments or procedures for your face or skin?
If yes, please describe.
What specific concerns or goals do you have for your facial or skincare treatment?
If yes, please describe.
Do you have a history of skin conditions, such as acne, rosacea, or eczema?
If yes, please describe.
CONSULTATION FORM

FACIAL & SKINCARE
Treatment Considerations:
Are you a smoker or regularly exposed to secondhand smoke?
Do you frequently expose your face to the sun? Do you use sunscreen on your face?
Do you engage in activities that might stress or damage your skin, such as intense physical activity or outdoor work?
Are you following any specific dietary restrictions or diets that could impact your skin health?
Are you aware of the post-treatment care needed to maintain optimal results?
Do you have any upcoming events or occasions that could affect your availability for treatment or recovery?
Are you willing to follow post-treatment care instructions, including using specific products or avoiding certain activities?
Are you pregnant or breastfeeding?
Have you recently undergone exfoliating or peeling treatments onyour face?
By signing below, you agree to the following:
- I have completed this form accurately and truthfully to the best of my knowledge.
- I agree to inform the technician of any changes to the information previously provided.
- I release the technician and their employer from all liability for any harm or losses resulting from falsification or omission of my medical history.
Full Name:
Date Signed:

MonthDayYear
Date
Signature
CLIENT CONSENT FORM

FACIAL & SKINCARE
I hereby consent to and authorize First Name Last Name
To perform the following procedure:
I acknowledge that side effects may occur, and I fully accept this risk. I understand that my Skincare Technician will take every precaution to minimize or eliminate any potential negative reactions. If I experience any complications following my treatment, I agree to consult my Skincare Technician first. I have been given the opportunity to ask questions, and all my concerns have been addressed to my satisfaction.

I confirm that I have read the provided information and have recorded my

medical history accurately, including all pertinent details. For future services, I

agree to inform my Skincare Technician of any changes to my medical

status or the information provided above. I understand that spa services are

not medical treatments, and therefore, the Skincare Technician cannot

prescribe medical treatments or pharmaceuticals.

I understand and agree that my Skincare Technician may determine it is

unsafe for me to continue a treatment due to health-related concerns. In

such cases, I may be required to provide a medical release from my

physician before resuming the treatment.

I confirm that the information provided above is accurate and complete to

the best of my knowledge, and I have not withheld any information that may

be relevant to the treatment I am receiving. I accept full responsibility for any

side effects that may occur. I consent to the skincare procedure,

understanding that it is an elective treatment and no medical claims are

implied. I agree to follow the verbal and written aftercare instructions

provided to me.

By signing below, I herby acknowledge that I have completely read and fully understand the above agreement.
Technician
Client
TREATMENT RECORD

FACIAL & SKINCARE
CLIENT INFORMATION:
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Skin Analysis
Skin Type:
Pores:
Moisture content:
Elasticity:
Acne:
Skin sensitivity:
Fine lines (Glogau scale):
TREATMENT RECORD

FACIAL & SKINCARE
Known allergies:
Medications:
Previous treatments:
Life style:
NOTES
PHOTOGRAPH AND VIDEO RELEASE FORM

FACIAL & SKINCARE
CLIENT INFORMATION:
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
We kindly request your permission to use these photos for advertising purposes, such as portfolios, online and print ads, and similar materials. Your consent is essential for us to proceed. Please review the options below and indicate your preference by circling the appropriate response and providing your signature. Additionally, we love tagging our clients in photos shared on our Instagram profile! If you'd like to allow or decline this, please let us know by selecting the corresponding option below. Thank you!
Client Signature:
Date Signed:

MonthDayYear
Date
CANCELLATION POLICY

FACIAL & SKINCARE
Our goal is to provide quality care in a timely manner. To ensure this, we have implemented an appointment and cancellation policy.
Appointments are in high demand, and canceling early allows another client the
opportunity to access timely care. This policy helps us optimize the use of available
appointments for all our clients. When booking your appointment, you will be required to pay a $30 deposit, which will be applied toward the cost of your treatment(s).
Time is specifically reserved for your appointment, procedure, or treatment. If you
need to cancel or reschedule, you must notify us at least 24 hours before your
appointment to retain your deposit or have it applied to a future booking. If less
than 24 hours' notice is provided, the deposit will be forfeited.
If you arrive more than 15 minutes late for your appointment, it will be considered a no-show, and your deposit will be forfeited.
We are happy to answer any questions regarding this cancellation policy.

I have read and fully understand the above Appointment Cancellation Policy and agree to be bound by its terms. I agree to pay the cancellation fee in the event of a missed appointment.
Full Name

First NameLast Name
Signature
Should be Empty:

CONSULTATION FORM

Health & Medical History

Facial & Skincare History

CONSULTATION FORM

CLIENT CONSENT FORM

TREATMENT RECORD

Skin Analysis

TREATMENT RECORD

PHOTOGRAPH AND VIDEO RELEASE FORM

CANCELLATION POLICY