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  • Consult Form

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    Nz Z
    16 views2 pages
    This document is a facial consultation form for a client of Beauty Rave Medispa. It collects information about the client's skin concerns, current skincare routine, allergies, previous treatments, and has the client acknowledge risks and agree to update the spa on any medical changes. The form asks for the client's name, phone number, age, main skin concerns, current products used, allergies, previous procedures, and has a liability waiver and signature line.

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    Original Title

    CONSULT FORM

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    This document is a facial consultation form for a client of Beauty Rave Medispa. It collects information about the client's skin concerns, current skincare routine, allergies, previous treatments, and has the client acknowledge risks and agree to update the spa on any medical changes. The form asks for the client's name, phone number, age, main skin concerns, current products used, allergies, previous procedures, and has a liability waiver and signature line.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    16 views2 pages

    Consult Form

    Uploaded by

    Nz Z
    This document is a facial consultation form for a client of Beauty Rave Medispa. It collects information about the client's skin concerns, current skincare routine, allergies, previous treatments, and has the client acknowledge risks and agree to update the spa on any medical changes. The form asks for the client's name, phone number, age, main skin concerns, current products used, allergies, previous procedures, and has a liability waiver and signature line.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    VE

    UTY RA M

    ED
    FACIAL CONSULTATION FORM
    ISP
    EA

    B A

    NAME:

    PHONE NUM: AGE:

    WHAT ARE YOUR CONCERN REGARDING YOUR SKIN?


    ACNE BLACKHEADS OILY SKIN

    DULL SKIN WHITEHEADS UNEVEN SKINTONE

    DRY SKIN ENLARGED PORES WRINKLES/ FINE LINES

    OTHERS:

    WHAT IS YOU CURRENT SKINCARE ROUTINE?


    CLEANSER MOISTURIZER SUNSCREEN

    TONER RETINOL MASK

    SERUM EXFOLIIANT EYE CREAM

    ESSENCE NIGHT CREAM OTHERS:

    DO YOU HAVE ANY ALLERGIES?

    IS THERE ANY INFORMATION WE SHOULD KNOW BEFORE


    BEGINNING YOUR TREATMENT?
    VE
    UTY RA M

    ED
    ISP
    EA

    B A

    HAVE YOU HAD ANY OF THE FOLLOWING?

    BOTOX INJECTIONS LASER

    CHEMICAL PEELS FILLERS

    COSMETIC SURGERY OTHERS:

    IT IS YOUR RESPONSIBILITY TO INFORM BEAUTY RAVE MEDISPA OF ANY


    PRE-EXISTING AND ALL HEALTH CONDITIONS. IT IS ALSO YOUR
    RESPONSIBILITY TO INFORM BEAUTY RAVE MEDISPA ANY DISCOMFORT
    DURING OR AFTER ANY SESSION WITH US.

    I
    UNDERSTAND AND ACCEPT ANY RISKS OF WHICH I HAVE BEEN
    ADVISED ASSOCIATED WITH THE AGREED UPON SKIN TREATMENT.
    I RELEASE BEAUTY RAVE MEDISPA FROM ALL LIABILITYARISING
    FROM ANY INJURY AND/OR DAMAGE FROM FAILURE TO INFORM
    BEAUTY RAVE MEDISPA OF ANY PRE-EXISTING CONDITIONS,
    LIMITATIONS SPECIFIC SENSITIVITIES AND/OR DISCOMFORT DURING
    THE TREATMENT.
    I AGREE TO KEEP BEAUTY RAVE MEDISPA UPDATED AS TO ANY
    CHANGES IN MY MEDICAL PROFILE.

    CLIENT'S SIGNATURE:

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