Client Consultation
Please note this form must be kept for a minimum of 7 years for insurance purposes (all sections need to be completed)
Here at iBeauty we take your privacy seriously and will only use your personal information to administer your profile and to provide the services you have requested from us. In order for iBeauty to provide you with our services we will need to collect some personal information. We will use this information for iBeauty to provide the services you have requested.
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I consent to the collection and use of my personal information with regards to my treatments.
We need your permission to contact you with regards to appointment bookings, confirmation & reminders, information regarding your appointments, special offers & aftercare etc. We will not send any information or correspondence that is not regarding your appointments with iBeauty.
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I consent to iBeauty contacting me via email, phone, text message, apps, post or social media.
Some treatments require us to take a before & after photo i.e eyebrow definition, henna brows etc. We will always inform you before taking any pictures. Sometimes we like to show others your transformations and use them for advertising & marketing, if you consent to your picture taken and/or for use by iBeauty please choose an option below.
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I consent to iBeauty taking my picture for treatment purposes only
I consent to iBeauty taking my picture for treatment purposes and use for advertising & marketing.
Name
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First Name
Last Name
Date of Birth dd-mm-yy
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Address
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Street
Street name
Town/City
State / Province
Postal code
Phone Number
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-
Phone Number
Email (we do not share info. this enables us to send you special offers, newsletters etc)
example@example.com
How did you hear about iBeauty Salon?
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Website / Online Search
Facebook
Referral
Other
If Referral, please list name
If Other, please let us know
Your Beauty Profile
Medical Information
We need to gather this information for safety purposes and to evaluate if you are suitable for your requested treaments.
Doctors/surgery name
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Doctors surgery Address & phone number
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Do you suffer from any of the listed conditions. If any are marked yes, please go into more detail in the space provided.
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NO
Respiratory problems
Asthma
COPD
Heart conditions/pacemaker
Cuts/abrasions
HIV
Hepatitis
Stroke
Severe circulatory disorders/DVT
Blood disorders
Haemophilia
High/low blood pressure
Skin disorders
Eczema
Psoriasis
Dermatitis
Cancer
Diabetes
Kidney problems
Epilepsy
Hormone imbalance
Swelling/oedema
Operations within 6 mths
Recent scar tissue/surgery
Prone to keloid scarring
Metal plates/pins/piercings
Limitation of body movement
Arthritis
Claustrophobia
Anxiety
Depression
Nail Disorders (i.e fungus etc)
Athletes foot
Warts/Verrucas
Allergies
Other
Please give more detail about any of the conditions you have ticked above.
Do you take any medication this includes over the counter medication, vitamins, herbal remedies or hormones? If yes please list the items as it may effect your service today.please go into more detail in the space provided below.
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Yes
No
Please give more detail about any medications.
Have you had any of the following carried out in the last 2-4 weeks?
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Botox
Fillers
Retinol or Roaccutane Products containing fruit acids
Microdermabrasion
Microneedling
Chemical peels
Laser/IPL
Steroids (including topical steroids)
Ultra violet exposure
Vaccinations
NO
Other
Please give more detail about any of the treatments you have ticked above.
Are you pregnant? (There may be some treatment that are not suitable during pregnancy or at particular stages of pregnancy)
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yes
no
If yes please state due date
How would you describe your skin. Tick all that apply.
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Oily
Dry
Combination
Sensitive
Mature
Congested
Do you have a skin care routine?
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Yes
No
Please give more detail if you answered yes above.
Give details of any treatments you have received in the past (i.e waxing, nail extensions, brow treatments etc)
Have you ever had an adverse reaction to any treatments in the past?
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Yes
No
If yes please give details.
ONLY FILL OUT IF PATCH TEST IS REQUIRED. I have received a patch test for the treatment listed below a minimum of 48hrs before treatment was carried out.
Yes
Patch test received for treatment
Eyebrow/Eyelash Tint
Brow lamination
Lash lift
Henna
Other
SALON USE ONLY - DO NOT FILL IN THERAPIST FILL IN PATCH TEST DETAILS
UPDATE AS REQUIRED
If you would like to send us any pictures of any skin/nail concerns etc please do so here.
What about this picture do you like/do not like?
THANK YOU FOR TAKING THE TIME TO FILL IN YOUR CONSULTATION FORM THIS WILL ENABLE US TO PROVIDE YOU WITH THE BEST TREATMENT AND EXPERIENCE POSSIBLE. IF YOU ARE UNSURE ABOUT ANYTHING CONCERNING YOUR CHOSEN TREATMENT PLEASE CONTACT iBEAUTY.
I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the service being received. I declare that the above information I have given concerning my health is correct
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Yes
Signature
*
Submit
SALON USE ONLY - TREATMENT RECORD CARD
Therapist record treatments carried out.
Date/Treatments carried out
Products used - always insert treatment date
Additional notes - always insert treatment date
Should be Empty: