SPRAY TAN CONSULTATION & CONSENT FORM
CLIENT INFORMATION
Name:
First Name
Last Name
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Referral:
Date of Birth:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
I am over 18
SKIN EVALUATION
Your skin type: (check all that apply)
Very Fair
Fair
Medium
Dark
Very Dark
Sensitive
Acne
Oily
Dry
Normal
Does your skin easily tan or burn in the sun?
Burn
Tan
How often do you moisturize your skin?
Exfoliate your skin?
What products are you currently using?
TREATMENT CONSULTATION
Do you have any of the following?
Allergies
Hypersensitivity
Skin disorder(s)
If yes, please indicate:
Are you taking any medication or being treated for a skin condition(s)?
Yes
No
If yes, please indicate:
Are you pregnant, breast feeding or undergoing IVF?
Yes
No
Have you had any recent wounds, tattoos, piercing or surgery?
Yes
No
Have you ever had a spray tan before ?
Yes
No
Do you suffer from any respiratory problems?
Yes
No
Have you undergone hair removal in the last 24 hours?
Yes
No
Do you have bleached hair or eyebrows?
Yes
No
All of our products undergo extensive testing in line with industry standards and comply with all applicable requirements to ensure that they are safe. However, a person's reaction to any product is personal to them and products of any kind can cause allergic or other reactions. We strongly recommend that all of our customers participate in a skin sensitivity test at least 24 hours prior to the full application of any product, to reduce the risk of an adverse reaction, even if previously used. However, you are responsible for your own safety and it is your decision as to whether you wish to participate in a test or not. Please check the box below, then sign and date this Consultation Form to confirm your understanding.
I acknowledge that applying any product to the skin or hair is never entirely without risk.
Signed:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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