Facial Consent Form

First & Last Name

Phone Number

What are your long term skin goals?

What are your areas of concern?

Please list all allergies you have

Are you currently undergoing medical treatment for any skin conditions from a physician? This encompasses conditions such as acne, rosacea, eczema, psoriasis, or any other skin disorders.

Have you used or taken Accutane within the past 12 months?

Have you ever received a diagnosis of skin cancer on the face, neck, scalp, or V-area? *Physician's approval required at the time of service*

Are you pregnant or lactating?

Have you had a facial within the last 2 weeks?

Have you had a microdermabrasion treatment within the last 4 weeks?

Have you had a chemical peel or laser treatment within the last 8 weeks?

Have you ever had an adverse reaction to a cosmetic product?

If yes, please explain

Have you ever had an adverse reaction to a skin care treatment?

If yes, please explain

Are there any health issues you have that we should know about? This includes conditions like cancer, diabetes, arthritis, lupus, psoriasis, or any other health concerns.

Have you used any Retin-A or Renova products in the past 12 months?

If yes, when

Do you expose yourself to UV rays through outdoor tanning or tanning booths?

If yes, how often

Free Text

Consent & Agreement

Free Text

By providing my name below, you confirm the following:

I have filled out this form to the best of my ability.
I agree to promptly inform my esthetician provider of any changes.
I acknowledge and understand the contraindications of the requested treatments.
I certify that I do not have any conditions that would render the treatment unsuitable for me.
I agree not to hold Beauty Oasis or my technician accountable for any inaccuracies in the form.

Client Name

Date

First & Last Name

Phone Number

What are your long term skin goals?

What are your areas of concern?

Please list all allergies you have

Are you currently undergoing medical treatment for any skin conditions from a physician? This encompasses conditions such as acne, rosacea, eczema, psoriasis, or any other skin disorders.

Have you used or taken Accutane within the past 12 months?

Have you ever received a diagnosis of skin cancer on the face, neck, scalp, or V-area? *Physician's approval required at the time of service*

Are you pregnant or lactating?

Have you had a facial within the last 2 weeks?

Have you had a microdermabrasion treatment within the last 4 weeks?

Have you had a chemical peel or laser treatment within the last 8 weeks?

Have you ever had an adverse reaction to a cosmetic product?

If yes, please explain

Have you ever had an adverse reaction to a skin care treatment?

If yes, please explain

Are there any health issues you have that we should know about? This includes conditions like cancer, diabetes, arthritis, lupus, psoriasis, or any other health concerns.

If yes, please explain

Have you used any Retin-A or Renova products in the past 12 months?

If yes, when

Do you expose yourself to UV rays through outdoor tanning or tanning booths?

If yes, how often

Free Text

Consent & Agreement

Free Text

By providing my name below, you confirm the following:

I have filled out this form to the best of my ability.
I agree to promptly inform my esthetician provider of any changes.
I acknowledge and understand the contraindications of the requested treatments.
I certify that I do not have any conditions that would render the treatment unsuitable for me.
I agree not to hold Beauty Oasis or my technician accountable for any inaccuracies in the form.

Client Name

Date