• Dermadesigns Beauty and Laser Clinic

    Consultation form

  • Compulsory Disclaimer

    The information on this form will be used to correctly evaluate your indivdiual needs and is strictly confidential. a 100% cancellation fee applies if you do not notify the salon you cannot atten your appointment within 24 hours of your appointment time. If you no show for a pre-paid package, you will forfeit the treatment.

     

    Our schedule is planned to coordinate and allow correct time for each service. Arriving late will lessen your treatment time. Arriving more than 15 minutes late will be an automatic rescheuduled appointment.

    I, the undersigned, understand and ackowledge and agree that: (i) I am aware that the facilities and services involve risks, including but not limited to, risk or bodily injury or death (ii) I have provided on this form, all the relevant information regarding my medical history and health conditions. I confirm that the answers I have given are correct and I have not withheld that may be relevant to my treatment, health and safety.

  • Date
     - -
  • Are you currently pregnant, trying to become pregnant or breastfeeding?
  • Are you currently lactating?
  • Are you a smoker?
  • Do you wear contact lenses?
  • Do you have eyelash extensions?
  • Are you currently menstruating?
  • Are you of Aboriginal or Torres Straight Islander decent?
  • Would you like to be left alone to relax whilst your mask is on?

  • If any of your information changes, including new medications, please notify your therapist as soon as possible. Thank you.

  • LASER CLIENTS

  • Do you have any allergies to metal?
  • Are you currently taking any medication that has light sensitivity side effects
  • Do you have a history of keloid/hypertrophic scarring?
  • Do you have a history of skin cancer or mole removal?
  • Have you had any botox or filler injectables in the last 2 weeks?
  • Have you been diagnosed with any hormonal imbalances?

  • I agree that the information I have listed is accurate and I have not withheld any information. I acknowledge my therapist has asked me if I have any questions and has answered them to my satisfaction. I have been warned of all side effects and theur likelyhood.

  • Date
     - -
  • Should be Empty: