Client Release and Intake FormWe look forward to serving you! Name * First Name Last Name Email * Phone (###) ### #### Emergency Contact Name * Emergency Contact Phone Number * (###) ### #### Any Major Health History * Please list any allergies (skin or other): * Do you have any skin conditions or concerns: * Yes No Are you currently taking any medications (i.e. blood thinners, acne medications)? * Do you wear contact lenses? If so, please ensure they are removed during services. * Yes (if needed please ask for a contact lens case) No Release of Liability: I, the undersigned, acknowledge that I have voluntarily chosen to receive esthetician services, including but not limited to lashes, brow, facial, waxing services. I understand that every treatment carries inherent risks, and I accept full responsibility for any adverse effects resulting from this treatment. I hereby release and hold harmless the esthetician and Stay Gold Beauty LLC from any liability. * Yes No Photo Release: I grant permission for my likeness and photographs to be taken during the services and used for promotional purposes including, but not limited to, social media, website, and marketing materials. * Yes No Please check here if you are ok with photographs that do not disclose your identity (face will be hidden) Additional Comments/Questions/Concerns Signature (Type Name) * Date MM DD YYYY Thank you!
