Facial Consent Form Sample For Students

Facial Treatment Consent Form

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First Name

Email Address

Last Name

Date of Birth

Sex

Phone

What Facial Products You Are Currently Using :

Cleanser

Do You Use Day Cream

Do You Use Toner ?

Do You Use Night Cream ?

Do You Use Serum ?

Do You Use Mask ?

Are you using Retin-A, Hydroquinone, Accutane or AHA products within the last 6 months ?

Yes

Did you have facial , Laser Hair Removal , Glycolic Peels or Injections done in the last two weeks ?

Yes

Are you pregnant or trying to get pregnant ?

Yes

NoDo you have any metal implants / pacemaker ?

Yes

Do you have a history of : Heart Problems, High Blood Pressure, Cancer ?

Yes

Initials

I have not had any facial waxing or laser hair removal within the last 7 days.
I have not had any chemical peel of any kind within the last 14 days.
I agree to pay the individual and package fees quoted to me and all fees are non-refundable.
I understand for effective results is best achieved through a series of treatments and compliance to the home care product program recommended by a COMPANY NAME OR THERAPIST NAME therapist and result very on individuals.
I have informed the COMPANY NAME of all health problems of which I am aware.
Facial treatments may consist of surface cleansing, exfoliation, galvanic current equipment, high-frequency electrotherapy, application of serums, cream, extractions and masks. Treatments take approximately 30 minutes to complete and are designed to balance, hydrate, cleaning, lifting or skin tightening and prepare the skin for the home care regimen.

OTHER SERVICES YOU MAY BE INTERESTED IN :

Slimming Treatment

Other Service Name

APPOINTMENT POLICY AGREEMENT :

In order to work ina timely manner and provide quality service to all clients who need and desire treatment. COMPANY NAME will enforce the following policies :

If you cannot make your scheduled appointment, you must call us or email at least 24 hours in advance of any appointment you need to miss, cancel or reschedule. I understand that reminder calls services or email may be provided as a courtesy, are not guaranteed; and should I not receive one, I am still responsible for my appointments and any consequences associated with failing to keep or be on time for appointments. I understand that if I am late for an appointment and COMPANY NAME cannot fit me in without inconveniencing other clients, that session may be lost without reimbursement. All missed or no show appointments will be recorded in your profile.

Late Arrival : If you arrive more than 10 minutes late for your scheduled appointment, you will be rescheduled to another day. If you arrive less than 10 minutes late for your scheduled appointment, you may result in shortened appointment and we still reserve the right to reschedule your appointment if there is need to spend extra time for your treatment.

Failure to cancel or reschedule appointments appropriately, not only affects the staff, but also other clients who may have been in need of that appointment time. Please be respectful of your time and ours.

All treatments, packages and products are non-refundable.
Any unused or expired services in your package will not be refunded.
Treatment expire one year from date of purchase / redeem.

I HAVE READ, UNDERSTOOD AND AGREE TO AIDE TO THE ABOVE AGREEMENT.

Your Signature

Today's Date

( please have parent or guardian to sign if you are under 18 year old. )

Thanks for submitting!