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Consent Form
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Home
Services
About
Consent Form
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New Clients
Consent Form
Please complete my consent form prior to your appointment.
First Name
Last Name
Phone Number
Email
Date of Service
Service Booked
-- Select Service --
Express Refresh Facial
Signature Facial
Platinum Facial
Microdermabrasion
Hydrofacial
Dermaplaning
Chemical Peel
DMK Enzyme Treatment
Carboxy Mask
KRX Green Sea Peel
Health & Skin Information
Known allergies or sensitivities
None
Yes
If you answered 'Yes' to the previous question, please list known allergies or sensititivities here.
Current skin conditions or concerns:
None
Acne
Wrinkles
Rosacea
Eczema
Psoriasis
Cold Sores
Irritation/Rash
Open Wounds
Sunburn
List any other skin conditions here:
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