Miles of Beauty Spray Tanning Consent Form

Name

First NameLast Name

Date

Phone Number

Area CodePhone Number

Email

example@example.com

Have you shaved/waxed in the last 24 hours?

YesNo

Have you had a patch test? **Recommended for pregnant women or those with sensitive skin

YesNo

If not please confirm you are happy to proceed with your treatment

Yes, I am happy to proceedNo, I will reschedule

Have you had any surgery or medical treatment in the last 12 months? If Yes, please explain

Do you suffer with any respiratory problems?

YesNo

Are you pregnant or breastfeeding?

YesNo

Do you have any skin or pigmentation disorders?

YesNo

Is your skin hypersensitive?

YesNo

Have you any known allergies?

YesNo

If yes please specify:

Have you any open cuts/wounds/rashes?

YesNo

Have you recently had any body piercings or tattoos?

YesNo

Do you wear contact lenses?

YesNo

Have you had any recent Botox or fillers?

YesNo

Do you have bleached hair?

YesNo

Have you applied deodorant or moisturiser today?

YesNo

Have you brought loose dark clothing for your tan?

YesNo

Is the tan for a special occasion?

YesNo

Have you had a spray tan or used tanning products before?

YesNo

What was your experience?

What tan would you like to achieve?

How well do you tan in the Sun?

Any questions?

Disclaimer: I declare that I have read and understood and answered the questions to the best of my knowledge. I have no known medical conditions or allergies that may affect or induce a harmful reaction from a sunless tanning treatment.

The information above is for the therapists records only and will not be misused or passed on to any other third-parties.

Signature

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