• 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.*
  • I have read and understood the policies of “THE BEAUTY JEM” (found on her website or Instagram @thebeautyjem story highlights with the name “policy”). 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-Facial Care

  • Before your facial appointment

    - Please avoid the use of any acne medications, scrubs, acids, exfoliants, retinol, and products with active ingredients at least 2 weeks before your appointment. - Botox, laser, electrolysis, microneedling, chemical peels, and/or filler injections must be done two weeks before your facial. - No waxing, threading, or shaving the treatment area for 1-2 days prior. - Avoid sunburn or tanning at least 2 weeks before your appointment. - Come with clean skin, free of makeup or heavy skincare. - Drink plenty of water to keep your skin hydrated.

  • After your facial appointment

    - Direct sunlight exposure is to be avoided immediately following the treatment (including any strong UV light exposure and/or tanning beds). If some sun exposure cannot be avoided first apply a broad spectrum sunscreen of SPF 30 or higher. - Facial massage, radio frequency, and other facial tools/machines may cause temporary redness/pinking of the skin; this is a normal and positive outcome that indicates an increase in blood flow as a result of the treatment. Otherwise, it should go away in a few hours. - If you have any concerns, please let me know prior to the treatment. Please keep in mind that you may experience breakouts following the facial. Because the facial is so stimulating, it brings all of the pimples to the surface, it's all part of the healing process! - Maintain a simple skin care routine for the next three days. A gentle cleanser, moisturizer, and an SPF of 30 or higher are required. - Exfoliating ingredients and products, as well as retinol, should not be used within 7 days of your service because over-exfoliation can cause irritation or further sensitivity. - Drink plenty of water to keep your skin hydrated. - Change your pillowcases the night of your facial appointment. - Avoid touching/picking your face, sweating, or putting makeup products on for 24 hours. - We cannot guarantee absolute results because individual reactions to treatment vary. By choosing to receive treatment, you acknowledge and accept responsibility for any potential outcomes or reactions that may occur. We encourage open communication and will do our best to address any concerns you may have throughout your treatment. We want you to understand that we put our clients' safety and well-being first. Please be assured that we are fully committed to maintaining the highest level of care and safety.
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