Client consultion Form
  • Client consultion Form

  • CLIENT INFORMATION

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  • MEDICAL HISTORY

  • Do you have any of the following conditions: 

    * Acne
    * Arthritis
    * Asthma
    * Blood disorder
    * Cancer/Chemotherapy
    * Dermatitis
    * Diabetes
    * Eczema
    * Epilepsy/Seizures
    * Fever blisters
    * Heart condition
    * Herpes
    * Hepatitis
    * High blood pressure
    * HIV/AIDS
    * Hyperpigmentation
    * Hypopigmentation
    * Hysterectomy
    * Immune disorders
    * Insomnia
    * Keloid scarring
    * Low blood pressure
    * Lupus
    * Organ Failure
    * Metal bone pins/plates
    * Phlebitis (blood clots)
    * Pregnant/Breastfeeding
    * Seizure disorder
    * Skin diseases
    * Seborrhea
    * Transplant
    * Warts

  • Any recent surgery including plastic surgery?

  • CLIENT SKIN CONCERNS

  • SKIN CARE HISTORY

  • CLIENT CONSENT FORM

    Please read this in its entirety
  • I have carefully read and fully understand the medical questions outlined above and have disclosed all relevant conditions that apply to me. I acknowledge that it is my responsibility to inform the technician of any changes in my medical history or health status, both now and in the future, to ensure my safety and the accuracy of my care.


    I, the undersigned, voluntarily consent to the facial treatment provided by Kendra Leach at Amaze Beauty Spa.
    Iacknowledge that I have provided accurate and complete information regarding my medical and skin history. I understand that this information is essential for ensuring the safety and effectiveness of the treatment.

    I understand that the facial treatment involves the application of various skincare products and techniques. I consent to the esthetician's professional judgment in selecting the appropriate products and procedures based on my skin type and conditions.

    I acknowledge that it is my responsibility to inform the esthetician of any changes to my medical or skin history that may occur in the future, as this may affect the suitability of the treatment.

    I have been informed that, despite the esthetician's efforts to maintain a safe and hygienic environment, there are inherent risks associated with facial treatments. I assume these risks willingly and release Amaze Beauty Spa and Kendra Leach from any liability for adverse reactions or unforeseen complications that may arise during or after the treatment.

    I grant permission for photographs to be taken before, during, or after the treatment for documentation and educational purposes, ensuring my anonymity and confidentiality.

    By signing below, I confirm that I have read, understood, and agreed to all terms in this form, and I give my informed consent to proceed with the facial treatment.

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