• Client Consent & Release Form

    Client Consent & Release Form

    Your comfort, safety, and satisfaction are my top priority. Honest communication helps us create the best experience!
  • This consent form provides important information regarding skincare, lash, permanent makeup, and other esthetic services offered. By signing, you acknowledge that you have received and reviewed this information, even if you are not receiving a specific service at this time. This ensures you are fully informed for both current and any future treatments you may choose to receive.

  • Format: (000) 000-0000.
  • How did you hear about us?*
  • Health & Medical Information

  • Do you have any allergies (including adhesives, lidocaine, pigments, skincare ingredients)?*
  • Health History | Please check any of the following that applies to you
  • Skincare Treatments (Facials, Peels, Extractions, etc.) 

  • I understand that skincare treatments are designed to improve the health and appearance of my skin, but results vary depending on my skin type, condition, lifestyle, and aftercare. I acknowledge the following:

    • Treatments may involve the use of professional-grade products, exfoliants, enzymes, or chemical peels, which can cause temporary redness, dryness, tightness, sensitivity, or peeling.

    • Extractions may cause temporary redness, swelling, or minor scabbing.

    • Chemical peels or advanced treatments (such as microneedling, dermaplaning, or microdermabrasion) may increase sensitivity to the sun and require diligent SPF use afterward.

    • Some treatments may not be suitable if I am pregnant, breastfeeding, have certain medical conditions, or am using specific medications (such as Accutane, Retin-A, or topical prescriptions).

    • Failure to follow recommended aftercare (including avoiding sun exposure, heat, harsh products, or picking at the skin) may negatively impact results and increase risk of irritation or complications.

    • Skincare treatments are not a substitute for medical dermatological care.

    • While improvements in skin condition are expected, no specific results are guaranteed.

    By initialing, I acknowledge that I have disclosed all relevant skin conditions, medications, and allergies to my esthetician. I release my esthetician from liability for temporary reactions or outcomes within the normal scope of skincare treatment.

  • Lash Extensions / Lash & Brow Services

  • I understand that lash and brow services are cosmetic procedures that involve the use of professional adhesives, tints, solutions, or styling techniques to enhance the natural appearance of my lashes and brows. I acknowledge the following:

    Adhesives & Products: The adhesives, tints, and solutions used during lash or brow services may cause temporary redness, irritation, watery eyes, itching, swelling, or allergic reactions. A patch test may be recommended, but it does not guarantee the absence of a reaction in the future.

    Aftercare Responsibility: I will follow all aftercare instructions provided, including avoiding oil-based products, steam, saunas, rubbing, picking, or pulling at the lashes and brows. I understand that improper care can shorten the lifespan of lash extensions or cause brow lamination/tint results to fade prematurely.

     Maintenance: Lash extensions are semi-permanent and require regular touch-ups (fills) every 2–3 weeks to maintain fullness. Brow lamination and tinting are temporary and will gradually fade over several weeks.

     Potential Effects: Lash extensions may cause natural lashes to shed prematurely or become weaker over time if not cared for properly. Brow services may temporarily overprocess or slightly dry the brow hairs.

     Removal: I agree not to attempt to remove lash extensions on my own and understand that only a professional should remove them using safe removal products. Improper removal can cause natural lash loss or damage.

     Contraindications: These services may not be recommended if I have certain medical conditions (eye infections, chronic dry eyes, blepharitis, alopecia, skin sensitivities, or recent eye surgery). I have disclosed all relevant medical history to my esthetician.

     Results: I understand that results vary depending on natural lash/brow condition, lifestyle, skin type, and aftercare. No specific result is guaranteed. 


    By initialing, I acknowledge that I have been informed of the potential risks and responsibilities associated with lash extensions and brow services.

  • Permanent Makeup (Brows, Eyeliner, Lips, etc.)

  • I understand that permanent makeup (PMU), also known as cosmetic tattooing, is a form of tattoo procedure in which pigment is implanted into the skin to enhance or define my features. I acknowledge the following:

    Permanency & Fading: I understand this is a tattoo procedure and results are permanent but will naturally fade over time. Touch-ups may be required to maintain desired results.

    Multiple Sessions: I acknowledge that multiple sessions may be necessary to achieve the desired color, shape, and density. The healing process may cause uneven fading, requiring a follow-up session.

    Healing Process: The treated area may go through stages of scabbing, flaking, and color lightening. Final healed results may differ from immediately after the procedure.

    Color & Skin Factors: Pigment color may heal differently depending on my skin type, undertone, age, sun exposure, skincare products, medications, and lifestyle habits (such as smoking).

    Risks & Reactions: As with any tattoo, there are risks of allergic reaction, pigment migration, scarring, or infection if aftercare is not followed. Numbing agents may cause temporary swelling, redness, or irritation.

    Touch-Ups: I understand that future touch-ups are not included in the initial procedure cost unless specified by my esthetician, and that pigment fading varies from person to person.

    Limitations & Contraindications: I have disclosed all relevant health conditions (such as pregnancy, breastfeeding, diabetes, skin disorders, or blood-borne illnesses). I understand PMU may not be suitable for everyone and that my esthetician reserves the right to refuse service if it is unsafe.

    No Guarantees: I accept that results cannot be guaranteed, as healed outcomes depend on individual skin healing responses.

     
    By initialing, I release my esthetician from liability for undesired healing results, pigment loss, need for touch-ups, or individual variances in healed appearance.

  • Risks & Acknowledgements

  • I understand that with all cosmetic services, potential risks include (but are not limited to): irritation, swelling, allergic reactions, scarring, pigment migration, infection, or unsatisfactory results.


    I release my esthetician and business from liability for any unforeseen side effects or outcomes and understand that services are performed at my own risk.

  • Would you like to have a patch test which we highly recommend? (Note that a patch test does not guarantee that an adverse reaction will never happen)*
  • Photography Consent*
  • I understand that the services provided by my esthetician are non-medical, cosmetic treatments intended to enhance appearance and promote well-being. I acknowledge that results vary depending on individual factors and that no guarantees can be made.


    I confirm that I have disclosed all medical conditions, allergies, and medications that may affect my treatment. I agree to follow all pre- and post-care instructions provided by my esthetician.

    By signing below, I confirm that I have read and fully understand this consent form. I have disclosed all medical history and conditions that may affect my treatment. I voluntarily agree to proceed with services provided by my esthetician.

     

  • Date*
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    2 digit month, 2 digit day, 4 digit year
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