Consent Form for Esthetician Services

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone

(###)

###

####

Do you have any known allergies?

No

Yes

Are you currently taking any medications?

No

Yes

Do you have any chronic skin conditions?

No

Yes

Are you undergoing any medical treatments?

No

Yes

I have provided accurate information about my health and medical history.

Agree

I understand esthetician services are not a substitute for medical treatment.

Agree

I consent to the use of discussed products and techniques.

Agree

I acknowledge potential risks, including allergic reactions and skin irritation.

Agree

I agree to follow post-treatment care instructions.

Agree

I consent to the use of my personal information for providing services.

Agree

I consent to having photos or videos taken during my treatment for use on social media and promotional materials.

Agree

I can withdraw my consent or discontinue services at any time.

Agree

Name *

By entering your name below, you consent to the terms and conditions outlined in this form.

First Name

Last Name

Today's Date *

MM

DD

YYYY