• Returning Client Consent Form

  • Do you give your permission for me to take photos and videos before, after, and during the session to catalog your results?*
  • If yes, do I have your permission to post treatment photos/ videos to my business Instagram: @radiant_jade_esthetics ?*

  • Please answer the following questions to ensure you are not contraindicated for your service.

  • Do you currently have any open wounds or active cold sores/ fever blisters on the treatment area?*
  • Do you currently have sunburned, windburned, extremely dry, chapped or irritated skin?*
  • In the last two days have you received facial waxing, skin care facial, or laser hair removal?*
  • In the last week have you used any topical and/or oral prescription strength medications such as Retin-A, received Botox, injectables, or dermal fillers, received dermaplaning or microdermabrasion?*
  • In the last two weeks have you received a chemical peel, microneedling, or microblading?*
  • In the last month have you received IPL?*
  • In the last 6 months have you undergone chemotherapy, radiation, used Accutane, or undergone laser or cosmetic surgery?*

  • Terms & Conditions

  • I understand, have read, and completed this form truthfully.

    I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures.

    I understand that my information is strictly confidential.

    I give consent for all future treatments.


    I acknowledge that the esthetician holds the right to terminate the session at any time.

    I have been informed of and understand the contraindications to the requested treatments and agree that I do not have any condition(s) that would make the requested treatment unsuitable.

    I will inform my esthetician of any discomfort I may experience at any time during my treatment to allow her to adjust accordingly.


    I understand that withholding information or providing misinformation may result in contraindications and/or irritation from treatments received.


    I understand that if I am allergic to one or more ingredients in the products used, I may experience allergic reactions.


    I release the esthetician from any and all liability associated with any injuries/current and future conditions resulting from the skincare procedures or products used and assume full responsibility thereof.

  • Date Signed
     - -
    2 digit month, 2 digit day, 4 digit year
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