Auravé Skin Ritual Client Intake & Consent Form
Please complete this form prior to your appointment.
This allows us to personalize your experience and ensure your safety and comfort.
Full Name:
*
Phone Number:
*
Email:
*
Date of Birth:
Address:
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Skin Type
*
Dry
Oily
Combination
Sensitive
Skin Concerns
*
Acne
Aging/ Fine lines
Pigmentation
Dryness
Sensitivity
Dullmess
How often do you typically receive facials?
*
Every 2-4 weeks
Once a month
Every 2-3 months
Occasionally
This is my first facial
Have you had any recent medical aesthetic treatments?
*
Yes
No
If yes, please specify (e.g., Botox, fillers, laser, microneedling):
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Currently using
Retinol
Accutane
Exfoliating Acids
None
Allergies
Do you have any medical conditions or history we should be aware of?
Heart condition / surgery
Metal implants
Pacemaker
None
Other
Are you currently pregnant or nursing?
Yes
No
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Consent & Agreement
I understand that the facial treatments and skincare services I receive at Auravé Skin Ritual are for relaxation and skincare purposes only. I acknowledge that I have disclosed all relevant medical conditions, allergies, and medications. I understand that results may vary and no guarantees have been made. I consent to receive facial treatments and agree to hold Auravé Skin Ritual and its providers harmless from any liability.
Do you agree to the above terms?
*
Yes
Signature (Type your full name)
*
Submit
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