ESTHETICIAN CONSENT FORM PERSONAL INFORMATION Name City Address Email Address Is this your first facial? Yes No What are your main skin issues? Are you currently taking any medications? Yes No Do you have any medical conditions? Are you currently pregnant? Yes No Do you have any allergies? Yes No Would you consider your skin sensitive? Yes No Would you say you have dry or olly skin? Are you often out in the sun? Yes No Do you use tanning beds? Yes No Have you had a reaction to any skincare products in the past? Yes No If so, which ones? Are you sensitive to temperature? Yes No Do you have any preferences, dislikes or sensory issues that we should be aware of? Yes No Describe your current skincare routine. What products are you currently using? Yes No Do you understand the treatments you're about to recelve? Yes No Do you understand the after care instructions? Yes No Has our staff member explained everything to you in detail and answered all of your questions? Yes No Is there anything else that you think we should know before starting your appointment? Date Signature Send