Facial Consent Form
Facial Consent
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Name
Do we have your permission to show your non-identifying photos or videos for educational purposes on our social media or our before/after pictures? *
Required
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Date
MM
/
DD
/
YYYY
Service *
Required
Have you ever had a facial before?
Do you have dental implants? *
Required
Do you have any allergies to food, cosmetics or drugs? *
Are you pregnant? *
Required
Are you presently taking any medications? *
Required
Have you ever experienced any burning, itching, redness or irritation on your face? *
Required
What are your main areas of concern (if any) or anything you would like to maintain *
Are you currently using any of the following products? *
Required
Brand Name:
By my signature below, I certify that I have read and fully understand the contents of this Informed Consent and that the disclosures referred to herein were made to me. I do not hold my Esthetician responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today. *
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