OBS Client Intake Form

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Date: *

YYYY

Full Name: *

Date of Birth *

YYYY

Sex *

Male

Female

Address *

Phone Number *

E-mail *

Emergency Contact & Phone Number: *

Do you have any of the following conditions? *

Acne

Autoimmune Disorders

Asthma

Cold Sores, Fever blisters

COPD

Cancer

Diabetes

Dermatitis

Eczema

Epilepsy

Glaucoma

Heart Disease

Hepatitis

Herpes simplex

High/Low Blood Pressure

Hives

Hemophilia

HIV/AIDS

Hyper/Hypothyroidism

Hysterectomy

Keloid, Hypertrophic scars

Lupus

Migraines

Phlebitis/Blood Clots

Psoriasis

Rosacea

Skin Infections

Seborrhea

Thyroid Condition (Other)

Tina

Varicose Veins

Warts

Any other condition that is not listed above

NONE OF THE ABOVE

Required

Please list any medications you take regularly, including vitamins, herbal supplements, aspirin, and topicals: (If not applicable, please list NONE.) *

Any known allergies? (If not applicable, please list NONE.) *

Any recent surgery, including plastic surgery ? (If not applicable, please list NONE.) *

FEMALE CLIENTS ONLY!

Please SELECT, if applicable

Pregnant or Nursing

Trying to become Pregnant

Taking birth control pills

Undergoing any hormone replacement therapy

NONE OF THE ABOVE

Clear selection

Are you currently using products containing any of the following ingredients> *

Any exfoliating scrub

Any beta hydroxy acids (BHAs)

Renova/Retinoids

Any hydroxy acids (AHAs)

Vitamin A derivative (i.e. retinol)

Hydroquinone

NONE OF THE ABOVE

Required

Have you received Botox, Restylane, or Collagen injections in the last 6 months? *

Yes

Disclosure

I have read and completed this questionnaire truthfully. I understand that withholding information or providing inaccurate details about my medical history, allergies, medications, and skincare routines may lead to contraindications or adverse reactions to the treatments I undergo. I agree to inform the technician of any changes in the above information.

Type Your Name to Agree to the Statement Listed Above *

O Beauty Services Cancellation Policy Agreement

Our goal is to provide quality care in a timely manner. In order to do so, we have had to implement an appointment/cancellation policy.

Appointments are in high demand, and your early cancellation will give another person the opportunity to have access to timely care. This policy enables us to better utilize available appointments for our clients.

Time has been specifically reserved for your appointment, procedure, or treatment. If you need to cancel or reschedule your appointment you must notify us at least 12 hours prior to your appointment. If you provide less than 12 hours’ notice a $25.00 cancellation fee will be added to your account and charged.

If you arrive more than 15 minutes late for your appointment it is considered a no-show and will also result in a $25.00 cancellation fee at checkout. It is at the sole discretion of the available technician on whether the remaining time of the booked service can be performed. Additional time will NOT be added to your original service time and there are no guarantees that service can be preformed for a late arrival.

I have read and fully understand the above Appointment Cancellation Policy and agree to be bound by its terms. I agree to pay the cancellation fee in the event of a missed appointment.

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