Consultation and Release Form

Name

First NameLast Name

Email

example@example.com

Address (for mobile clients only)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Would you like to receive appointment reminders and follow-up messages via text?

YesNo

Date of Appointment

Date

Please send a recent, makeup-free, filter-free selfie so I can see your natural skin tone and undertone. This helps me bring the perfect custom shade for your spray tan.

Natural skin color:

How does your skin react to sun exposure?

Burns easilyBurns then tansTans easily without burning

Desired shade: (I’ll get you as close to your desired shade as your skin can beautifully support.)

MediumDarkUltra Dark

Do you prefer a rapid-rinse tan (you can rinse in 3–6 hours based on desired shade) or a standard-rinse tan (rinse after 8+ hours)? Both options develop to the same final color, this just affects when you can shower.

RapidStandard

Have you had a spray tan before?

YesNo

If yes, how did your skin react? Did the color develop well, fade evenly, or were there any issues?

Are you currently taking any medications that may affect your skin (e.g., acne meds, steroids, antibiotics)?

YesNo

Recently used Retinol, Accutane, or prescription skin products?

YesNo

Skin conditions (eczema, psoriasis, rosacea, vitiligo):

Do you have any autoimmune conditions or chronic illnesses?

YesNo

If yes, please list:

Do you have any mobility limitations, physical considerations, or use any assistive devices?

YesNo

If yes, please list:

Are there any positions that are difficult or uncomfortable for you to maintain? (e.g., standing for extended periods, raising arms overhead, turning)

YesNo

If yes, please list:

Do you have a prosthetic limb, implant, or medical device I should be aware of during application?

YesNo

Do you need any breaks during the session?

YesNoMaybe

Are you sensitive to any of the following?

Spray mist sensationTouch or pressure on skinBright lights

Are there any areas of your body you are not comfortable having touched or sprayed?

YesNo

Is there anything about the process I should know to make you feel more comfortable?

Pregnant or breastfeeding?

YesNo

Recent sunburn?

YesNo

Spray tan/self-tanner in last 2 weeks?

YesNo

Will this spray tan be for a special event or travel? If so, please include the date. Also, will you be swimming, at the beach, or sweating heavily during this time?

I understand the importance of following pre- and post-tan care instructions. (Please initial)

I understand that results may vary depending on my skin type and preparation. (Please initial)

By reading and signing, you acknowledge and understand the following:

To my knowledge, I have no medical conditions or allergies that would prevent me from receiving a spray tan. I understand there is a possibility of an allergic reaction and have reviewed the ingredient list if I have known allergies. I agree to discontinue use and consult a doctor if any reaction occurs. If pregnant or with health concerns, I understand I should consult a doctor before tanning. I waive any and all claims for medical complications that may arise.

I understand DHA (the active ingredient in sunless tanning) is FDA approved for external application. For misting, the FDA recommends avoiding inhalation, ingestion, and eye contact by using protective eyewear, nose filters, lip balm, and undergarments.

I acknowledge that spray tans may not react favorably on all skin types, and first-time clients should schedule at least one session prior to a wedding, prom, photoshoot, or other important event.

Spray tans do not contain SPF and will not protect against the sun.

I am responsible for any staining or damage to jewelry, clothing, or accessories worn before or after my session. Leather and silk can be permanently stained by tanning solution; use caution. I understand the cosmetic bronzer will rinse off during my first shower, that my spray tan will continue to develop for up to 24 hours, and that results generally last up to 7 days but vary based on skin preparation, maintenance, products used, lifestyle, medications, and skin type.

I agree to follow the recommended rinse time provided.

I have been provided with and understand all pre- and post-tan care instructions.

For clients receiving services at the home studio location, I understand that by attending my appointment, I am voluntarily entering a private residence and receiving services at my own risk. I agree to release and hold harmless The Perfect Glow Brentwood and its owner from any claims, liabilities, injuries, accidents, losses, or damages that may arise while on the premises, whether occurring before, during, or after my appointment.

I consent to receiving a spray tan and release The Perfect Glow Brentwood and its employees from all liability, claims, or causes of action related to these services.

I have read and fully understand this consent form.

Signature

Date