Spray Tanning

Name*

First NameLast Name

Email*

example@example.com

Address (address of appointment if mobile)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

I understand I am not to shave/wax any later than 24 hours before my appointment *

YesNo

Have you had a patch test?*

YesNo

If not please confirm you are happy to proceed with your treatment*

Yes, I am happy to proceedNo, I will reschedule

Do you suffer with any respiratory problems?*

YesNo

Are you pregnant or breastfeeding?*

YesNo

Do you have any skin or pigmentation disorders?*

YesNo

Is your skin hypersensitive?*

YesNo

Have you known any allergies?*

YesNo

Have you any open cuts/wounds/rashes?*

YesNo

I understand that I am not to wear moisturizer before my spray tan*

YesNo

I understand that I am to wear loose dark clothing after my tan*

YesNo

Is the tan for a special occasion?*

YesNo

Have you had a spray tan or used tanning products before?*

YesNo

Where did you hear about On The Glow *

Any Questions or Concerns?

Disclaimer: I declare that I have read and understood and answered the questions to the best of my knowledge. I have no known medical conditions or allergies that may affect or induce a harmful reaction from a sunless tanning treatment. I understand that On The Glow is not responsible for any stains or damage to clothing due to spray tan solution.

I understand that spray tan results may vary based on individual skin type, preparation, aftercare, and product adherence. On The Glow Mobile Spray Tanning is not responsible for uneven fading, unexpected color development, or results affected by personal skin chemistry, medications, or improper prep and post-tan care.

The information above is for the spray tan technicians records only and will not be misused or passed on to any other third-parties.

Signature*

Date*

Date