Adara Beauty & Wellness Medspa
Model Call Pre-Screening Form
Name:
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Date of Birth:
-
Month
-
Day
Year
Date
Which treatment(s) are you interested in modeling for?
Botox/Xeomin
Lip Filler
Dermal Filler
Hyperhidrosis Treatment
Chemical Peel (VI Peel, BioRePeel)
Microneedling
Other
Have you received any cosmetic treatments in the past 6 months?
Yes
No
If yes, please list:
Do you have any of the following? (Check all that apply)
Pregnant or breastfeeding
Active cold sores
Allergies to lidocaine or injectable products
Skin infections in treatment area
None of the above
Are you comfortable with your photos/videos being used for training or social media?
Yes
No
Photo Submission Required:
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Adara Beauty & Wellness Medspa
Model Call Pre-Screening Form
Please submit clear, well-lit photos of the area you wish to have treated:
Front view
Left side
Right side
(Facial treatments require clean, makeup-free skin)
Submit photos to: info@adarabw.com or upload them with this form.
Preview PDF
Submit
Should be Empty: