Medical Intake & Consent

Home Facial For Deep Cleansing, Relaxation & Energy Balance

Medical History & Skin Health
Please answer all questions honestly. This information helps ensure your treatment is safe and suitable for your skin and health condition.
Skin Concerns & Routine
This helps us customize your treatment based on your skin needs.
Client Consent & Liability Waiver
Please read carefully before providing your consent: I understand that facial and skincare treatments involve the application of cosmetic products, tools, and professional equipment directly onto my skin. I acknowledge that results may vary depending on individual skin conditions, and multiple sessions may be required to achieve optimal results. I confirm that I have accurately and fully disclosed all relevant medical information, allergies, medications, and skin concerns. I agree to inform the therapist of any changes to my health prior to future treatments. I understand that while professional hygiene and safety standards are followed, there is always a possibility of adverse reactions, including redness, irritation, sensitivity, breakouts, or temporary discomfort. In rare cases, stronger reactions may occur, including but not limited to: • Allergic reactions • Dermatitis • Burns or blistering • Hyperpigmentation or scarring I understand that individual skin responses cannot be fully predicted, even with patch tests. If I experience discomfort at any time during the treatment, I will immediately inform the therapist. I agree that the therapist shall not be held responsible for any adverse reaction, injury, or outcome resulting from: • Undisclosed or incorrect medical information • Sensitivity or reactions unique to my skin • Failure to follow pre- or post-treatment care instructions I understand that this service is a non-medical cosmetic treatment, and no medical claims or guarantees of specific results are being made.
Signature & Final Confirmation
Please sign and confirm the information provided is accurate.