If you are booking a treatment for the first time at Indulgence Beauty Salon then you may wish you fill out the Client Consultation form below and email it to us. Alternatively you can fill out the form when you arrive at the salon for your first treatment (kindly arrive 15 minutes early for your first treatment with us).
Fields marked * are required.
Home Phone *
How did you hear about us
Are you currently or within the last year under a physician’s care? *
If yes please state
Are you currently being seen by a physician for a medical condition that is not completely diagnosed? *
Are You Currently Taking any Medication? *
Do you have any of the following medical conditions? (Please check all that apply)
Cancer Had Cancer in the last 5 years Diabetes High Blood Pressure Low Blood Pressure Arthritis Herpes Frequent Cold Sores HIV / AIDS Hepatitis Skin Disease Skin Lesions Seizure Disorder Hormone Imbalance Thyroid Imbalance Blood Clotting Liver / Kidney infection Any active infection Any Cuts or Abrasions Open Wounds Scar tissues Varicose veins
Do you have any other health problems or medical conditions? (Please state)
Are you taking any oral medications, if so please state or tick below?
Roaccutane Accutane Birth Control Pills Hormones Other
If other, please state
Are you Pregnant or trying to become pregnant, if yes how many weeks are you?
Do you currently have metal implants or a pacemaker? *
Please list any topical medications or creams you are currently using (including Retin A)
Have you ever had an allergic reaction to any of the following? Please check all that apply and describe the reaction you experienced
Tint Latex Cosmetics Massage Oils Wax Cosmetics Aspirin Lashes Other
Please describe any reactions and list any other allergies that you have experienced
Skin Care History
Are you currently under the care of a dermatologist? *
If yes, please state
Do you wear contact lenses? *
Do you have any special skin problems pertaining to your face or body? *
If yes, please specify
Have you ever had a chemical peel? *
If yes, please state when
Do you have a tendency to redness? *
Have you ever had laser hair removal? *
A patch Test has been performed by Indulgence Beauty salon for
Tinting HD Brows BD Brows Express & semi-permanent lashes Cluster Lashes LVL Lashes
Please agree to the terms and conditions below *
I certify that the preceding medical, personal and skin history statements are true and correct.
I accept that any treatment I have is taken at my own risk. I certify that I have read and have completed the above to the best of my knowledge. I understand that failure to disclose information requested above may result in adverse side effects, unknown because of this to which I accept full liability/responsibility. I am aware that it is my responsibility to inform the Therapist of my current and ongoing medical or health conditions and it is essential for the caregiver to execute appropriate treatment procedures. I acknowledge the possible side effects of any beauty procedure.
I understand that indulgence Beauty Salon reserves the right to charge for appointments cancelled or broken without 24 hours notice.
Would you like to me added to our mailing list and receive special offer and discounts form Indulgence Beauty Salon?
Client Print name*
Please enter the code shown