House of Laser and Aesthetics

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Consultation Form

Name

Date of Birth

YYYY

What are you main skin concerns?

Acne or blemishes

Elasticity

Fine lines/ Wrinkles

Dryness

Pigmentation

Uneven Texture

Large pores

Redness or sensitivity

facial structure

What skin treatments are you interested in?

Basic Facial

Luxury Facial

Micro needling

Dermabrasion

Filler

Anti-wrinkle Injections

Skin brightening IV

Microdermabrasion

HydraFacial

Have you had the above facial before?

Yes

Clear selection

If yes, were there any side effects or complications?

Disclaimers

Facials are designed for cosmetic improvement only and do not replace medical skincare or dermatological treatments.
Certain products may not be suitable for all skin types. A patch test may be recommended prior to treatment.
Clients are responsible for informing the practitioner of any changes to their medical history, medications, or skin condition before each visit.
Refunds cannot be issued once treatment has been performed.

Client Acknowledgment

I understand that facial treatments are designed to cleanse, exfoliate, and rejuvenate the skin but results vary by individual.

I understand that temporary redness, tingling, or mild irritation may occur following treatment.

I understand that some active facials may increase sun sensitivity, and I agree to use SPF protection after treatment.

I have informed my practitioner of all medications, allergies, and recent skin treatments.

I understand that certain facials may not be suitable if I have open wounds, sunburn, active acne, or infections.

I understand that it is my responsibility to follow all aftercare advice provided to maintain the best results.

I consent to the use of professional-grade skincare products appropriate for my skin type and concerns.

I have read and understood all the information and disclaimers above. I consent to receiving facial treatment(s) at House of Laser & Aesthetics Limited and acknowledge that potential side effects and aftercare have been explained to me.

Please sign below.

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