Treatment Consent Form - Wollaston Beauty Clinic (Test)

Name *

First

Last

Address 1st Line

Address 2nd Line

Adress 3rd Line

County

Post Code

Mobile

Landline

Email

Date of birth

Do you currently suffer from any medical conditions or injuries? *

Yes
No

If yes please provide details:

Are you currently taking any medication or supplements (including Vitamin A/retinol)* *

Yes
No

If yes please provide details:

Have you had any illnesses or operations in the last 6 months? *

Yes
No

If yes please provide details :

Do you suffer from any allergies or skin complaints? *

Yes
No

If yes please provide details:

If having a facial or lash tinting, are you wearing contact lenses? *

Yes
No

If having a facial, do you mind products in your hair? *

Yes
No

Do you have any metal plates or pins? *

Yes
No

Are you pregnant? *

Yes
No

Any other details we may need to know

How did you hear about us *

I would like to receive emails/texts to keep me updated & receive a birthday treat *

Yes
No

I’m happy to share my great results on Social Media *

Yes
No

Covid-19 Medical Questions *

Agree

You are required at this time to stay at home and self isolate if you have any of the following main symptoms of Corona Virus.Do you have a high temperature – this means you feel hot to touch on your chest or back.Do you have a new, continuous cough? – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)Do you have a loss or change to your sense of smell or taste? – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal.TO PROTECT OTHERS, PLEASE STAY AT HOME AND SELF ISOLATE FOR 7 DAYS IF YOU ANSWER YES TO ANY OF THESE QUESTIONS.Thank you for your co operation during this time.

Statement *

Agree

I confirm the above statements are true, and that the therapist cannot accept responsibility for any injury I may suffer attributable to me not having given full and true answers to the above questions, and agree to all salon terms & conditions including courses bought, loyalty points used, special offers, treating underage clients (HD require client to be over 18) and tint tests required every 6 months.*Vitamin A & retinol can contribute to skin sensitivity to waxing. Other contraindications to waxing could be hormonal changes and frequent waxing to the same area, especially eyebrows. Please inform us if you have ever experienced skin tearing from eyebrow waxing and note this can occur from time to time. We recommend hot wax to prevent tearing. YOUR PERSONAL DATA IS PROCESSED SO THAT WE CAN DO THE FOLLOWING: Collect specific personal data (name, address, email, contact number, DOB) that is required to enter into a contract to sell a product or service. Engage in communication with you including conformation and reminders of appointments, and requests to cancel or change bookings. Collect Health information to perform the agreed services appropriately, and potentially highlight areas that products and services may cause issues to clients because of their health. Ensure a safe service and provide industry standard advice. Select relevant offers, promotions and information for you. Estimate the number of customers we have. Hold personal data that is required by law or to respond to legal process. Hold for insurance purposes. For full information of our privacy policy please go to our website wollastonbeautyclinic.co.uk

Todays date *