Garden_Skin_Intake_and_Consent

Garden Skin Co. - Client Intake Form

Full Name

Date of Birth

Date

- Phone Number

Email Address

example@example.com

2. Do you have any allergies (including skincare ingredients, nuts, or latex)?

3. Are you pregnant or nursing?

4. Are you taking any medications, supplements, or herbal remedies? If yes list them:

5. Do you have any of the following conditions?

Check all that apply:

6. What is your primary skin concern:

7. What skincare products are you currently using: cleanser, serums, SPF, etc:

8. Have you had any recent facial treatments or cosmetic procedures (peels, Botox, microneedling)?

If yes, please explain:

4. How would you describe your skin?

Check all that apply:

Garden Skin Co. - Consent to Treat Form

By signing below, I confirm that:

1. I have completed the Client Intake Form to the best of my knowledge.

2. I understand that the skincare treatments provided are for the purpose of improving the condition and appearance of my skin.

3. I acknowledge that no guarantees have been made about treatment outcomes.

4. I understand that I must inform my esthetician of any changes in medications, health conditions, or skin concerns before future treatments.

5. I consent to receiving professional skincare services.

6. I release Garden Skin Co. and its practitioners from liability for any unintentional skin reactions or complications resulting from undisclosed conditions or failure to follow post-treatment instructions.

Signature

Date