Consultation Form 18+

Therapist AlkaPriyaEvaSeemaDeep Booking Slot Client Details: Client Name Client Email: Client Contact Number Client Date Of Birth Next of kin Details: Client Emergency Name & Relation (Optional) Client Emergency Contact Number (Optional) Client Health Details Do you have any of the following health conditions What areas of concern do you leave regarding your skin? Are you currently using any of the following? Are you using or have ever used any medications? Are you currently using skin care products ? If yes please state below: Are you taking any other medications listed or unlisted above or do you want to provide any additional information? Client sign

Client sign Date Client Acknowledgement & Liability Waiver It is client’s responsibility to inform Seema's Beauty Salon of any pre-existing or current health conditions list or non listed. You must also report any discomfort during or after treatment. By proceeding, you accept any risks associated with the treatment and release Seema’s Beauty Salon from any and all liability for any injury or reaction resulting from undeclared conditions, sensitivities, or delayed reporting. You agree to keep us updated on any changes to your medical profile. For any concerns, clients must inform or visit the salon as soon as possible. In emergencies or outside salon hours, you may contact a doctor or hospital if needed. Submit