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Fill in a Valid Facial Consent Form

The Facial Consent form is a crucial document used in skincare and beauty treatments to ensure that clients understand the procedures they will undergo. This form outlines the potential risks, benefits, and aftercare instructions associated with facial treatments. By signing, clients give their informed consent, allowing practitioners to provide services with clarity and confidence.

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➤ PDF File

Skincare Treatments – Client Information and Consent

Name

Address

City

State

Zip

Phone

E-mail

How did you hear about us?

Employer ___________________________________________________________________________________________________ Occupation

___________________________________________________________________________________________________________________________________________

What would you like to achieve from your skin treatment today? ______________________________________________________________________________________________________________________________________________________________

Skin Care History

Have you ever had a facial treatment or chemical peel before? __________ Yes __________ No

Which of the following most closely describes your skin type?

I	Creamy Complexion	Always burns easily, never tans
II	Light Complexion	Always burns, may tan slightly
III	Light / Matte Complexion	Burns moderately, tans gradually
IV	Matte Complexion	Seldom burns, always tans well
V	Brown Complexion	Rarely burns, deep tan
VI	Black Complexion	Never burns, deeply pigmented

Do you have any special skin problems or concerns? ______________________________________________________________________________________________________________________________________________________________________________________

Do you use Retin-A, Renova, or Retinol/vitamin A derivative products? __________ Yes __________ No

Have you used any alpha-hydroxy acid or glycolic acid products in the last 48 hours? __________ Yes __________ No

Are you currently taking Accutane or have you taken it in the past? _________ Yes __________ No How long ago? _____________________________________________

Have you used other acne medication? __________ Yes __________ No If yes, which one? ________________________________________________________________________________________________________________________________________

Are you exposed to the sun on a daily basis or do you use a tanning bed? __________ Yes __________ No

What skin care products are you currently using? Please list the brand if known:

Cleanser _____________________________________________________________________________	Toner ____________________________________________________________________________________
Mask ___________________________________________________________________________________	Moisturizer _________________________________________________________________________
Eye Product _______________________________________________________________________	SPF _________________________________________________________________________________________
Exfoliation / Scrubs __________________________________________________________	Night Cream _______________________________________________________________________
Treatment / Acne product ____________________________________________	Makeup Brand ___________________________________________________________________

Please circle any areas of concern you have regarding your skin:
	Breakouts / Acne	Blackheads / Whiteheads	Excessive Oil / Shine
	Rosacea	Broken Capillaries	Redness / Ruddiness
	Sun spot / Brown spots	Uneven Skin Tone	Sun Damage
	Wrinkles / Fine Lines	Dull / Dry Skin	Flaky Skin
	Dehydrated Skin	Sensitive Skin
Eyes:	Dark Circles	Puffiness	Fine lines
Please circle if you have ever had an allergic reaction to any of the following:
	Cosmetics	Medicine	Food
	Animals	Sunscreens	Pollen
	AHAs	Fragrance	Shellfish
	Latex	Collagen	Other: ___________________________________________________________________________________________________

Have you ever had Botox, Restylane, or other injections? ______________________________________________________________________________________________________________________________________________________________________________

Ladies only:

Are you taking hormonal contraceptives? __________ Yes __________ No

Are you pregnant or trying to become pregnant? __________ Yes __________ No Are you nursing? __________ Yes __________ No

Experiencing any menopause problems? ____________________________________________________________________________________________________________________________________________________________________________________________________________

Are you undergoing any hormone replacement therapy or cancer treatments? ____________________________________________________________________________________________________________________________________

I understand this consent form and have answered each question truthfully. I understand that withholding information from my skin care therapist may result in contraindications or skin irritation from treatments received. The skin care treatments I receive at Belle Waxing and Skincare are voluntary and I release Belle Waxing and Skincare from liability and assume full responsibility thereof.

Signature

Date

Documents used along the form

When preparing for facial treatments, several important documents are typically required alongside the Facial Consent form. These documents help ensure that clients are fully informed and protected throughout the process. Below is a list of commonly used forms and documents.

Client Intake Form: This form collects essential information about the client's medical history, skin type, and any allergies. It helps the practitioner tailor the treatment to the client's specific needs.
Bill of Sale: This legal document provides proof of ownership transfer and includes essential transaction details. For ease of use, you can complete the Bill of Sale form online by visiting https://pdfdocshub.com/.
Medical History Questionnaire: This document provides a detailed overview of the client's past medical conditions, medications, and treatments. It is crucial for assessing any potential risks associated with the facial treatment.
Aftercare Instructions: This form outlines the necessary steps for clients to follow after their facial treatment. It includes guidance on skincare, activities to avoid, and signs of complications to watch for.
Liability Waiver: This document protects the practitioner by having the client acknowledge the risks involved in the treatment. It ensures that the client understands and accepts responsibility for any potential outcomes.
Payment Agreement: This form details the costs associated with the facial treatment and any payment plans. It ensures that both parties are clear on financial obligations before services are rendered.
Follow-Up Appointment Schedule: This document helps clients plan their next visit. It may include recommendations for follow-up treatments based on the results of the initial facial.

Having these forms ready can streamline the process and enhance the overall experience for both the client and the practitioner. Proper documentation ensures clarity and helps maintain a professional environment.

Fill in a Valid Facial Consent Form

Common PDF Templates

Example - Facial Consent Form

Documents used along the form