Informed Client Consent Form

Have clients acknowledge the risks, aftercare rules and photo permissions tied to a treatment before you begin. It captures contact details, confirmation of the health history already provided, and signatures from both the client and the technician performing the service.

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Name

Date of birth

Address

Dirección

Ciudad

Estado / Provincia

Código postal

ZIP code

Phone

I understand the possible risks of the treatment and what to expect before, during and after it (tick to confirm)

The possible risks were explained to me I understand the aftercare instructions All of my questions were answered I know results vary from person to person

Treatment or procedure

Health history

I confirm I disclosed every health condition, allergy, medication and past reaction

I disclosed my health conditions I disclosed my allergies I listed medications and supplements I reported past reactions to products

Use of images

I allow photos to be used for advertising and promotional purposes

I allow use in any medium Social media only Before and after photos only I do not allow my images to be used

Signatures

Client name (printed)

Client signature

Date

Technician or esthetician

Date signed by the practitioner

No image

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