sb-salon.co.uk
07300040002
02381 22 87 86
Mon-Sat : 09.00-20:00 |
Sun : 10:00-18:00
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Seema
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Client Details:
Client Name
Client Address
Client Post code
Client Date Of Birth
Client Email:
Client Contact Number
Client Emergency Name
Client Emergency Contact Number
Please tick if you have any of the following health conditions
Pregnant
Aids/ Hiv
Cancer
Diabetes
Heart Problems
Hepatitis
High/Low Blood Pressure
Lupus
Recent Surgeries
Strokes
Other
None of the Above
Additional information health conditions
What areas of concern do you leave regarding your skin?
Breakouts/Acne
Blackhead/Whiteheads:
Dull/Dry Skin
Excessive Oil/Shine
Wrinkles/Fine
Dehydrated
Rosacea
Broken Catillaries
Enlarged Pores
Uneven Skin Tone
Sun Damage
Flaky Skin
Other
None of the Above
Is there any other information listed or not listed above / Surgery treatments/ any of the allergy I should know before beginning your treatment?
Are you currently using any of the following?
Retin A/Renova
Glycolic Acid/Alpha Hydroxy Acid Birth Control Pills
Hormone Replacement Therapy Hydroquinone
Topical Vitamin C Accutane
Sunscreen/ Sun Block
Other
None Of The Above
Are you using or have ever used any medications?
Acne
Cold Sores
Smoke
Had facials before
Tan
Electrolysis
Laser hair removal
Waxing (recently)
Other
None Of The Above
Are you currently using skin care products ?
Other-medications/additional infomation:
Client sign
Client sign Date
Guardian Sign
Guardian Sign date
Proof id client/Parent id
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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.
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