AV Beauty Facial Consent Form

AV Beauty Facial Consent Form
Name
Phone
Format: (000) 000-0000.
Email
example@example.com
Date of Birth

MonthDayYear
Date
Emergency Contact
1. Are you under the care of a physician or dermatologist?
If yes explain
2. Are you taking any medications (oral or topical)?
List
3. Allergies (including skincare ingredients or medications)?
List
4. Have you recently had (list all that apply):

Chemical Peel

Microdermabrasion

Botox/Fillers

Laser Treatments

Sunburn

Facial Surgery
List
Date of last treatment if any*

MonthDayYear
Date
5. Skin Concerns (list all that apply):

Acne/Breakouts

Dryness/Dehydration

Sensitivity

Hyperpigmentation

Oily Skin

Large Pores

Other
List
Before/After Photo Release (Optional)

I give AV Beauty permission to take before and/or after photos of my facial results. I understand these photos may be used for progress tracking, social media, and marketing

Yes, I consent to photos being taken and used

No, I do not consent to photos being taken or used
Signature
Date

MonthDayYear
Date
Date

MonthDayYear
Date
Product Recommendations Acknowledgment

I understand that my esthetician may recommend professional skincare products for home use to support my facial results. These recommendations are based on my individual skin concerns.

I acknowledge and understand these recommendations are optional I agree to notify AV Beauty of any reactions or concerns with recommended products

- Facial treatments aim to improve the health and appearance of my skin, but results vary.

- I may experience temporary redness, sensitivity, breakouts, or flaking.

- I have disclosed all medical conditions, allergies, and medications to the best of my knowledge.

- I will notify AV Beauty of any changes to my health or skincare routine.

- I release AV Beauty and its estheticians from any liability resulting from complications due to withheld information or unforeseen skin reactions.

I consent to receiving facial treatments at AV Beauty.
Client Signature
Date

MonthDayYear
Date
Esthetician Signature
Date

MonthDayYear
Date
Should be Empty: