Bloom A Skincare Studio Consent Form

Name   First Name*   Last Name*
Date of Birth   Date*
Phone Number   Area Code*   Phone Number*
Email   Email*
Emergency Contact Name  First Name*   Last Name*
Emergency Contact Phone   Area Code*   Phone Number*

Healthy History - Please check any that apply:

List out anything from the above.

Services to be Received - Please check all that apply:

Acknowledgment of Risks - I understand and acknowledge following. Please check each one.

Aftercare Responsibility

I have been informed of the appropriate post-treatment care and understand that it is my responsibility to follow these guidelines. I understand that not doing so may increase the chance of side effects or reduce the effectiveness of my treatment.

Waiver & Release

I confirm that all the information provided is true and complete. I understand the nature of the treatments I am receiving, the risks involved, and I consent to proceed. I release Bloom A Skincare Studio and its staff from any liability or claims related to the services provided.

Photo Consent (Optional):

Signature