• Facial Treatment Form

    Includes medical history, facial treatment history, skincare routine and appointment preferences, and consent & liability. Please fill it out truthfully and to the best of your ability, it should only take around 10 minutes. Should you have any questions or concerns, feel free to contact me at beautybyjemdj@gmail.com or Instagram @thebeautyjem.

  • Personal Information

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.

  • Medical History

    Please answer carefully and truthfully for your aesthetician to determine whether you are suitable and able to undergo the procedure and to rule out any contraindications.
  • Please check that applies to you currently or in the past:*
  • Please rate your stress level
  • What do you prefer during your appointment? (By the way, you can always ask for a silent appointment, just write it in your appointment notes when you book or let me know in person!)*

  • Your Skin History

  • Have you ever had a facial or skin treatment before?*
  • What are your specific concerns / challenges with your skin?*
  • What skin type do you think you have?*
  • How does your skin heal?*
  • Exposure of the sun?*
  • Does your skin bruise easily?*
  • Do you have a tendency to redness?*
  • What skin care products are you currently using on your face? Please check all that apply.*
  • Have you received any of these facial services in the last 14 days?*
  • If yes, please confirm the last date you had the procedure done
     - -
    2 digit month, 2 digit day, 4 digit year

  • Consent & Liability

  • I confirm I am over the age of 18 or have obtained parental/guardian consent*
  • I understand I am receiving a facial treatment service from "THE BEAUTY JEM/JEMIMA DE JESUS". I understand this procedure is a non-invasive skin resurfacing treatment that combines cleansing, exfoliation, extraction, hydration, and skin barrier protection, resulting in clearer, more beautiful skin*
  • I understand that I am not allowed to use acne medication (topical or oral), botox, laser, electrolysis, microneedling, chemical peels, filler injections, and/or any skincare that includes active ingredients such as, AHA/BHAs, exfoliants, and retinols for at least two weeks prior to my facial appointment. I also understand that I should avoid heavy sun exposure, sunbathing, or tanning for at least 1 week prior, and I should avoid waxing, threading, or shaving the treatment area for 1-2 days prior. Failure to follow this can lead to the risks listed below.*
  • I understand that some risks of this procedure may be, but not limited to, temporary redness, irritation, allergic reactions to products used, breakouts (rare) and sensitivity. I understand that even though my aesthetician will perform the service with precision and care, some clients may have an adverse reaction to the treatment. I voluntarily assume all such risks and release my aesthetician of all liability associated with receiving facial treatments.*
  • I agree to inform my aesthetician, "THE BEAUTY JEM", of any changes to my health or skin condition prior to future treatments. If I experience any discomfort during a session, I will immediately notify my aesthetician so that adjustments to the products or techniques can be made.*
  • I confirm and agree to disclose all known allergies, eye conditions, sensitivities, medications, or medical issues that may affect the outcome or safety of this procedure, and after my technician’s precautions I have still decided to proceed with application. I understand that withholding information or providing inaccurate details may lead to contraindications or adverse reactions during treatments. I understand and agree that my technician will not be held responsible if I experience any issues with my skin.*
  • I hereby grant to “THE BEAUTY JEM” the full right to take, publish and reproduce photographs of me, my face, my eyes and/or eyelashes, both before and after this procedure, solely for marketing purposes on a website or social media without any monetary compensation and/or discount vouchers.*
  • I agree to follow the care and maintenance instructions provided by the artist and that if any follow up care is required or failure to follow these instructions, I acknowledge this will be at my own expense and risk.*
  • I acknowledge that ‘THE BEAUTY JEM’ does not accept refund requests for facial services. I agree to communicate any concerns or dissatisfaction within 72 hours of my appointment to be eligible for a same-week corrective service or consultation.*

  • Please review The Beauty Jem policies before proceeding.

  • I have read and understood the policies of “THE BEAUTY JEM”. I understand that those policies and this consent and liability form will be in effect from now and all future appointments and will be applied if necessary and as “THE BEAUTY JEM” sees fit.*
  • I understand this agreement shall be governed by the laws of British Columbia. This agreement will remain in effect for this procedure, and all future procedures conducted by “THE BEAUTY JEM”. I release my aesthetician of “THE BEAUTY JEM/JEMIMA DE JESUS”, and the property owners of all liability and claims associated with this procedure.*

  • Pre & Post-Care

    View here: https://www.thebeautyjem.com/pre-and-post-care

  • Before your appointment:

    2 weeks before:

    • Stop using retinoids, tretinoin, acne medication, benzoyl peroxide, scrubs, exfoliants, acids (AHAs, BHAs), and other active-ingredient products.
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    • Do botox, laser, electrolysis, microneedling, chemical peels, and/or filler injections at least two weeks before your facial.
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    • Avoid other exfoliating treatments (microdermabrasion, at-home peels, scrubs).
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    • Avoid sun exposure, sunburns, tanning beds, and self-tanner on the treatment area.

     

    1-2 days before:

    • Avoid waxing, threading, tweezing, or shaving on the face.
      ​​
    • Stay well hydrated — your skin will respond better.​
      ​

    Day of your appointment:

    • Arrive with a clean face, free of makeup and skincare. If you arrive with makeup on, we may need extra cleansing time, and the full service amount still applies.
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    • Skip caffeine before advanced treatments if you're sensitive, as it can heighten skin sensitivity.

  • After your appointment:

    First 24-48 hours:

    • Avoid heavy makeup, especially foundation and concealer.
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    • No direct sun exposure or tanning beds including strong UV light. If sun exposure can't be avoided, apply broad-spectrum SPF 30 or higher.
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    • Skip hot showers, saunas, steam rooms, sweating, and intense workouts.
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    • Avoid touching, picking, or rubbing your face, including any peeling or flaking skin.
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    • Sleep on a fresh, clean pillowcase the night of your facial.
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    • For chemical peels and/or liquid microneedling treatments, some temporary redness or pinking of the skin is normal and often a positive sign of increased blood flow from the treatment, which typically fades within a few hours. Peeling, flaking, or mild sensitivity is also expected — let it happen naturally, don't peel or pick.
      ​

    First week:

    • No waxing, threading, shaving, or other facial treatments.
      ​
    • Avoid products with active ingredients, retinoids, exfoliating acids (AHAs, BHAs), benzoyl peroxide, acne treatments, scrubs, and any exfoliating tools for at least 7 days as over-exfoliation can cause irritation or further sensitivity.
      ​​
    • Mild breakouts following your facial can be part of the healing process because facials are stimulating and they often bring underlying congestion to the surface at a faster rate​.​
      ​

    Ongoing care:

    • Wear SPF 30 or higher every single day.
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    • Stick to a gentle, hydrating skincare routine suited for your skin type: cleanser, toner, serum, moisturizer, and SPF. We will provide recommendations of skincare products for you.
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    • Drink plenty of water to keep your skin hydrated and support recovery.
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    • For consistent results, we recommend a facial every 4–6 weeks to align with your skin's natural regeneration cycle. If you're following a treatment plan for a specific concern (acne, pigmentation, aging), stick to the recommended series for best results.
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    Important notes:

    Individual reactions to treatment vary based on skin type, lifestyle, and consistency of care, so results cannot be guaranteed. Please reach out if you have any concerns about how your skin is responding — we're always here to check in.

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