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Facial Treatment

Client Intake Form

CLIENT INFORMATION

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HEALTH & SKIN HISTORY

Have you had professional facial treatments before?
Yes
No
Do you currently have any skin conditions (acne, rosacea, eczema, psoriasis, dermatitis)?
Yes
No
Are there any open wounds, active breakouts, rashes, sunburn, or skin infections on your face?
Yes
No
Do you have sensitive skin or a history of reactions to skincare products?
Yes
No
Have you used retinol, retinoids, exfoliating acids, or prescription skincare products in the past 7 days?
Yes
No
Have you had any cosmetic procedures in the past 2-4 weeks (chemical peels, laser treatments, injectables)?
Yes
No
Are you currently taking any medications that may affect your skin?
Yes
No
Do you have any known allergies or sensitivities, including skincare ingredients?
Yes
No
Do you have a history of cold sores or herpes simplex in the treatment area?
Yes
No
Do you have a tendency to scar easily or experience delayed healing?
Yes
No
Have you experienced adverse reactions to facial treatments in the past?
Yes
No
Are you currently pregnant or breastfeeding?
Yes
No
What are your primary skin concerns or goals?
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FACIAL TREATMENT

Consent

TREATMENT DESCRIPTION

Facial treatments are non-invasive cosmetic services designed to cleanse, exfoliate, nourish, and improve the appearance and condition of the skin. Treatments may include cleansing, exfoliation, masks, massage, extraction, and the application of professional skincare products. Specific techniques and products used may vary based on skin type and condition.

I understand that results vary depending on individual skin type, lifestyle, and adherence to recommended skincare routines. No specific outcome can be guaranteed.

POSSIBLE RISKS AND SIDE EFFECTS

I understand that facial treatments may involve temporary side effects, including but not limited to:


  • Mild redness or sensitivity

  • Temporary irritation or dryness

  • Breakouts following treatment

  • Allergic reactions to products used


These effects are generally mild and temporary.

MEDICAL DISCLOSURE

I confirm that I have disclosed all relevant medical information, including skin conditions, allergies, medications, pregnancy or breastfeeding status, and recent cosmetic procedures.

PHOTO & VIDEO RELEASE

Form

I understand that these images and recordings may be used for the following purposes:


  • Client records and treatment documentation

  • Educational or training purposes

  • Marketing and promotional materials, including websites, social media, and advertising


I acknowledge that:


  • Participation is voluntary and not required to receive treatment

  • Images and videos remain the property of [Studio / Practitioner Name]

  • Images may be edited, cropped, or adjusted for professional use

  • My name or identifying information will not be disclosed without additional written permission


I understand that I may withdraw my consent for future use by providing written notice. I acknowledge that images or videos already published or distributed cannot be recalled.


I release [Studio / Practitioner Name], its employees, contractors, and representatives from any claims or liability arising from the use of photographs or videos as described above.

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