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Facial Informed Consent Form

Birthday
Month
Day
Year
What conditions would you like to improve?
Have you had facial treatments in the past?
Yes
No
How would you describe your skin?
How would you rate your skin?
I Always burns, never tans
II Always burns easily, tans slightly
III Burns moderately - tans gradually
IV Seldom burn- always tans well
V Rarely burns - Deep tan
VI Never Burns - Deeply pigmented
Do you ever experience
What is your current skincare routine?
Are you ever exposed to chemicals, oils or other caustic substances that may aggravate your skin?
Yes
No
Do you blush easily?
Yes
No
Do you
Have you ever had
Does your skin
Do you bruise easily?
Yes
No
Do you get sores/blisters (Herpes Zoster/ Shingles)?
Yes
No
Have you ever used
Any personal or family history of skin cancer?
Yes
No
How would you describe your overall health?
Excellent
Good
Fair
Poor
Please check all that apply for past and present:
Have you ever had a reaction to
For Women. Please check all that apply
For Men. Please check all that apply:

Informed Consent Release

I do fully understand all the questions above and have answered them all correctly and honestly. I understand that the services offered are not a substitute for medical care. I understand that the skin care professional will completely inform me of what to expect in the course of treatment and will recommend adjustments to my regimen if deemed necessary. I also am aware that individual results are dependent upon my age, skin condition, and lifestyle. I agree to actively participate in following appointment schedules and home care procedures to the best of my ability to obtain maximum effectiveness. In the event that I may have additional questions or concerns regarding my treatment or suggested home product routine, I will inform my skin care professional immediately. I release and hold harmless the skin care professional Lauren Leggio, Let's Glow Girls LLC, harmless from any liability for adverse reactions that may result from this treatment.

Policies

I value your time and appreciate your commitment to our appointments. To ensure smooth scheduling and fairness to all clients, the following cancellation and no-show policy is in effect:

  1. Card on File All appointments require a valid card on file at the time of booking. This card secures your spot and may be charged according to the cancellation and no-show policy outlined below.

  2. Cancellations or Rescheduling If you need to cancel or reschedule your appointment, you must provide at least 24 hours' notice. Any cancellations or reschedules made within 24 hours of the appointment time will result in the charge of 50% of the total cost of your booked appointments.

  3. Late Arrivals If you arrive 15 minutes or more after your scheduled appointment time, your appointment will need to be rescheduled, and result in the charge of 50% of the total cost of your booked appointments. This ensures that all clients receive their full treatment time and the schedule runs smoothly.

  4. No-Shows Failure to attend your scheduled appointment without prior notice will result in the charge of 50% of the total cost of your booked appointments. After two no-shows, you will be banned from booking future appointments.

  5. Refunds for Services Provided All services provided are final, and no refunds will be issued once the service is completed.

  6. Reporting Issues If you experience any issues with your service, please contact me within 24 hours of your appointment. I will do my best to address your concerns and ensure you’re satisfied with the results.

By booking an appointment, you agree to this cancellation and no-show policy. Thank you for your understanding and cooperation in helping me maintain a smooth-running business.


Date
Month
Day
Year

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