Ditzy Chic Esthetics — Model Call Application & Content Consent
Submit your application and choose your content permission level; selected applicants will be contacted with scheduling and treatment details.
Applicant Information
Full Legal Name
*
First Name
Middle Name
Last Name
Preferred Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
City
*
State / Province
*
Instagram Handle
TikTok Handle
Preferred Contact Method
*
Phone
Email
Text Message
Age Confirmation
*
I confirm that I am 18 years of age or older
Skin & Model Application
Skin concerns to be addressed
*
Acne
Fine lines
Hyperpigmentation
Dark spots
Dryness
Oiliness
Sensitivity
Redness
Texture
Enlarged pores
Uneven tone
Scarring
Other
Top skin concern
*
Skin type (if known)
Please Select
Normal
Dry
Oily
Combination
Sensitive
Dehydrated
Not sure
Current skincare products and actives
Allergies or sensitivities
*
Current medications relevant to treatment
Pregnancy or breastfeeding status
*
Not pregnant or breastfeeding
Pregnant
Breastfeeding
Prefer not to say
Current or previous isotretinoin use
*
No
Yes, current use
Yes, previous use
Date of last isotretinoin use
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Recent procedures and treatments
Chemical peel
Microneedling
Nano-needling
Laser/IPL
Waxing
Botox/Dysport
Fillers
Facial procedure
Surgery
None
Dates of recent procedures and treatments
Active cold sores, infection, or open wounds
*
No
Yes
History of reactions to facials or peels
*
No
Yes
Not sure
Upcoming major event within the next 14 days
*
Ability to follow pre- and post-care instructions
*
Yes
No
Not sure
Availability for model appointment
*
Flexible
Weekdays
Weekends
Evenings
Limited availability
Willingness to attend at 4604 Memorial Drive, Suite E, Waco, TX 76711
*
Yes
No
Clear makeup-free skin photos (front, left side, right side)
*
Upload a File
Drag and drop files here
Choose a file
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of
Model Expectations
Acknowledgment of treatment selection by esthetician after review of skin and health information
*
I understand and agree
Acknowledgment that results vary and are not guaranteed
*
I understand and agree
Acknowledgment that model appointments may take longer than standard appointments
*
I understand and agree
Acknowledgment to arrive on time, follow preparation instructions, and complete aftercare as directed
*
I understand and agree
Acknowledgment to disclose any changes in health, medications, allergies, pregnancy, or skincare before treatment, and that Ditzy Chic Esthetics may decline or modify treatment for safety
*
I understand and agree
Content Consent
Content permission level
*
Full Content Permission
Limited/Anonymous Content Permission
Private Treatment Documentation Only
Questions about content use or future requests
Final Consent
Confirmation
Typed Full Name
*
First Name
Last Name
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Application
Submit Application
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