Esthetician Consultation & Treatment Waiver

Client Information

First name

Last name

Email

Phone

Yes! I would like to receive beauty tips, exclusive offers, and business updates via email. (You can unsubscribe at any time.)

Which of the following best describes your skin type?

Type I Fair skin tones—Always burns, never tans

Type II Light skin tones—Burns easily, tans slightlyType III Fair to olive skin tones—Burns moderately, tans moderately

Type IV Light brown skin tones—Burns slightly, tans easily

Type V Dark brown skin tones—Rarely burns, tans easily

Type VI Dark brown to black skin tones—Never burns, tans easily

Do you have any special skin problems or concerns pertaining to your face?

No

Yes

Health & Safety Disclosure

Note: Failure to disclose this information can lead to adverse reactions. I agree to update the esthetician of any changes to my health or skin care routine before future appointments.

Have you used any of the following (check all that apply):

Current medications (specifically Accutane, Retin-A, or blood thinners)

Recent chemical peels, laser treatments, injections or facial surgeries

No/Does Not Apply

Are you currently pregnant or nursing?

No

Yes

Do you have any known allergies (especially to latex, nuts, aspirin, or fragrances)?

No

Yes

Terms & Conditions

1. Nature of Treatment: I understand that esthetic skin care treatments are cosmetic in nature and that results vary by individual. No specific results are guaranteed. 2. Potential Risks: I am aware that side effects may include, but are not limited to: redness, swelling, stinging, peeling, or temporary irritation. 3. Aftercare: I agree to follow all post-treatment instructions provided by the esthetician to ensure optimal healing and results.

Consent & Release

By signing below, I acknowledge that I have read this form in its entirety and have had the opportunity to ask questions. I voluntarily consent to the treatment and release DOLLFACE Skincare, LLC and its practitioners from any liability associated with the procedure.

Signature

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Esthetician Consultation & Treatment Waiver

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