Form
IVORY BEAUTY SPA
CLIENT CONSENT, REFUND & CHARGEBACK AGREEMENT
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
MEDICAL & SKIN HISTORY- Please list any allergies, medications, pregnancy or nursing status, skin conditions, recent cosmetic procedures, or other medical concerns.
SERVICES | PACKAGES CONSENT TO: (Checkboxes)
TREATMENT CONSENT & LIABILITY-
REFUND & CHARGEBACK AGREEMENT-
REQUIRED AGREEMENT CHECKBOX-
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Take Photo
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Should be Empty: