MKM Beauty Client Form

MKM Beauty Client Form

Please fill out the following information correctly and fully. Any questions that do not pertain to you please type "NA".
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Birth Date*

MonthDayYear
Emergency Contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Where did you hear about MKM Beauty?*
What service(s) will you be receiving at MKM Beauty?*

Lash ExtensionsLash Lift & TintBrow Shaping (wax)Brow LaminationBrow StainBody WaxingFace WaxingFacial
What service(s) have you received in the past? (from anywhere)*

Lash ExtensionsLash Lift & TintBrow Shaping (wax)Brow LaminationBrow TintBody WaxingFace WaxingFacial
Health History (please check all that apply)*
Are you able to lay/sit still for 2 hours or more if necessary?*

YESNOUNSURE
Do you have a habit of picking, pulling or playing with your lashes?*

Yes, out of habbitNot at allOccasionally with anxiety
Do you wear contact lenses or glasses?*

ContactsGlassesBoth contact and glassesNone
Are you diabetic or recieveing treatment related to diabetes?*

YESNO
Please list any known allergies and sensitivities (type NA if not applicable)*
Please list any current medications (type NA if not applicable)*
Are you pregnant?*

YESNO
What is your average stress level?*

1

2

3

4

5

1 is Not stressed, 5 is Very Stressed
Your appointment time is reserved just for you. A late cancellation or missed visit leaves a hole in the Esthetician’s day that could have been filled by another client. As such, we require 24 hours notice for any cancellations or changes to your appointment. Clients that provide less than 24 hours notice or miss their appointment will be charged a cancellation fee of 50% of the service. *
Eyelash Service Consent

Please read the following and check the box to give consent.
I understand that in rare occasions there are risks associated with having artificial eyelash extensions applied to or removed from my natural eyelashes. I understand that in rare cases as part of the procedure eye irritation and discomfort could occur. I agree that if I experience any of these conditions that I will contact the licensed eyelash professional and it may be beneficial to have the extensions removed.

I give consent to the placement and/or removal of the eyelash extensions or perming/tinting of my natural eyelashes by the licensed eyelash professional.

In any case of allergic reaction, minor chemical burn or irritation, we do not offer refunds but we can offer a free removal of the extensions if it is within 3 days of the initial eyelash appointment.
I have read and understood what is written above.*
Facial Service Consent

Please read the following and check the box to give consent.
I acknowledge that I am receiving professional skin treatments and/or facials from a licensed aesthetician who has been trained and certified in providing such services. I consent to the use of professional-grade products and equipment during my treatment, including chemical peels and enzymes, as deemed appropriate by my esthetician.

I agree to disclose any known skin conditions, allergies, sensitivities, medications, or medical treatments that may affect my skin or the outcome of the treatment.

I understand that while precautions are taken to minimize risks, adverse reactions such as irritation, swelling, or discoloration may occur.

If I experience any adverse reactions during or after the procedure, I agree to contact my esthetician immediately to address the issue and receive further guidance.
I have read and understood what is written above.*
Waxing Service Consent

Please read the following and check the box to give consent.
I understand that theres a risk of possible side effects after receiving a waxing treatment which include but are not limited to; mild irritation and redness. These side effects are temporary and generally fade within 48 hours.

I have not used Retin-A, glycolic peels, acutane or any form of chemical exfoliation in the past 72 hours. I understand that it is recommended to discontinue any use of physical or chemical exfoliant for 72 hours post waxing treatment.

I understand to prevent sun exposure or tanning beds for at least 72 hours post wax treatmant.

I understand not to participate in any physical activity that can result in sweating for the first 24 hours after receiving the waxing sertvice as it can result in irritation.

I understand that if I am not pleased with the result of the waxing service, I will communictae to my waxer such matter, but there will be no refund.
I have read and understood what is written above.*
Terms and Conditions

Please read the following and sign your name and date.
I have read and fully understand this agreement and all informtaion detailed above. I do not hold the professional responsible for any of my conditions that were present, but not disclosed at the time of the procedure, which may be affected by the treatment performed.

I understand and agree to the after-care instructions provided by the professional for the use and care of my eyelash, brow or body waxing treatment. I accept the consequences of failure to adhere to these instructaions may cause the service results to differ.

I understand that, while every attempt will be made to provide me with the desired look, everyone has different skin and hair, so my final result may not be the exact look that I had wanted within reason. Although it is impossible to list every potential risk and complication, I have been informed of the possible benefits, risks, and complications. I also recognize there are no guaranteed results and that the results are dependent upon age, skin condition and lifestyle.

MKM Beauty does not give refunds unless it is a special exception to our policies and is at managements discretion.

I give consent to these eyelash, brow, body waxing and other related services performed on me. By signing this agreement, I consent to the services performed by the licensed professional.
Signature*

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Date*

MonthDayYear
Date
First Impression?
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MKM Beauty Client Form

Eyelash Service Consent

Facial Service Consent

Waxing Service Consent

Terms and Conditions