Tanning Client Intake Form

Tanning Client Intake Form

MADD GLOW BEAUTY
Client Information
Full Name

First NameMiddle NameLast Name
Date

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Birth

MonthDayYear
Date
Emergency Contact Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Tanning Details / Service Info
Have you had a spray tan or sunless tan before?
When was your last tan?

MonthDayYear
Date
What is the occasion for your tan?
Preferred tan shade / color depth
How did you hear about us?
If other, please specify
Are you currently pregnant or breastfeeding?
Skin Type & History
Natural skin tone
How does your skin react to sun exposure?
Do you have any of the following skin conditions?

Other
If other, please specify skin condition
Do you have any known allergies?
If yes, please list your allergies
Are you allergic to any of the following?

Other
If other, please specify allergy
Have you had any recent skin treatments?

Other
If other, please specify skin treatment
When did you have the recent skin treatment(s)?
Medical / Health Questions
Currently taking any medications that may affect your skin?
If yes, please list the medications
Do you have asthma or breathing difficulties?
Have you ever had a history of fainting or dizziness?
Other medical conditions we should be aware of
Preparation & Aftercare Acknowledgment
Preparation Acknowledgment
Aftercare Acknowledgment
Consent & Liability Waiver
Liability and Consent
Consent Acknowledgment
Printed Name
Electronic Signature
Should be Empty:

Tanning Client Intake Form

Client Information

Tanning Details / Service Info

Skin Type & History

Medical / Health Questions

Preparation & Aftercare Acknowledgment

Consent & Liability Waiver