1. Spray Tan Intake Form
Please fill this in prior to your appointment
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Name *
Phone Number *
Email *
Date of Birth *
MM
/
DD
/
YYYY
Please tick where applicable: *
YES
NO
Pregnant/Lactating
Acne
Cuts or Abrasions
Recent Waxing
Recent Cosmetic Proceedures
Pigmentation Abnormalities
Respiratory Issues/Asthma
Have you had an allergic reaction to any of the following: *
YES
NO
DHA
Food
Medicine
Latex
Cosmetics
Fragrance
Iodine
Asprin
Skin Test (Select if/where appropriate) *
Excellent
Good
Fair
Poor
Moisture content
Muscle tone
Elasticity
Skin's healing ability
Date of last botox/fillers
Any other medical conditions: *
DISCLAIMER: I AGREE THAT THE ABOVE INFORMATION IS TRUE AND THAT I HAVE NO MEDICAL CONDITION THAT MAY AFFECT THE RESULT OF THE TREATMENT OR CAUSE A HARMFUL REACTION. I DO NOT KNOW OF ANY REASON WHY I SHOULD NOT RECEIVE THE TREATMENT AND UNDERSTAND THAT I AM TAKING THIS TREATMENT AT MY OWN RISK. I UNDERSTAND THAT RESULTS WILL VARY BETWEEN INDIVIDUALS AND NO GUARANTEES HAVE BEEN MADE REGARDING MY PERSONAL RESULTS. I UNDERSTAND THAT MY RESULTS MAY BE COMPROMISED IF I DO NOT FOLLOW THE AFTERCARE INSTRUCTIONS THAT I HAVE BEEN GIVEN.I UNDERSTAND THAT POTENTIAL SIDE EFFECTS INCLUDE: ALLERGY TO SOLUTION, ALLERGY TO LATEXT HOSE, IRRITATION, UNEVEN TAN, SOLUTION CAN STAIN UPHOLSTERY & FABRIC.
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