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Facial & Skincare
Client Intake Form

Client Information:

Medical History:

Do you have or have you had any of the following conditions? If yes, please select them:

Skin care

Please check current products you use:

Skin history

Skin concerns

By signing below, you agree to the following:

I have completed this form truthfully and to the best of my knowledge. I agree to inform the technician of any
changes in the above information. I agree that I do not have any condition/s that would make the requested
treatment unsuitable. I agree to waive all liabilities toward my technician and the employer for any injury or

damages incurred due to any misrepresentation of my health.

Facial & Skincare
Client Consent Form

I hereby consent to and authorize the technician at Anabelle Nail Cafe to perform the following facial treatment, including a microneedling procedure . I have voluntarily chosen to undergo this treatment after the nature and purpose of the procedure, along with the associated risks and hazards, have been explained to me.
  • Although it is impossible to list every potential risk and complication, I have been informed of possible benefits, risks, and complications. I also recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require further treatments of the treated areas to obtain the expected results at an additional cost.
  • I have read and understand the post-treatment home care instructions. I understand how important it is to follow all instructions given to me for post-treatment care. In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care, I will consult the esthetician immediately.
  • I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically.

By signing below I agree to the following:

I have completed this form to the best of my ability and knowledge. I agree to inform the technician of any
changes in the above information. I agree that do not have any condition(s) that would make the requested
treatment unsuitable. I will inform the technician of any discomfort I may experience at any time during my
treatment to allow them to adjust accordingly. I agree to waive all liability toward my technician and the
salon for any injuiry or damages incurred due to any misrepresentation of my health.

 

This agreement will remain in effect for this procedure and all future follow-ups conducted by the technician. I
understand that this consent agreement is legal and binding. I have read and fully understand all information
in this agreement. I am over 18 years of age and consent to the agreement and to the brow lamination
procedure, or if I am under 18 years of age, I have had my parent or legal guardian consent to this agreement,

and his or her relationship to me is as follows:

By his or her signature below, he or she ratifies and consents to this procedure under these terms.