Client Consent & Health Declaration Form

Please read each section carefully and complete the form in full. This information is kept confidential and used solely to ensure your safety and comfort.

First name

Last name

Birthday

Email

Phone

Date of Appointment

Health and Medical Information

1. Are you currently pregnant?

Yes

No

2. Do you have any known allergies (e.g., to wax, skincare products, adhesives)?

Yes (Please Specify)

No

2.1 If you answered Yes to the above question please provide more details.

3. Do you have any medical conditions or skin conditions that may be relevant to your treatment (e.g., eczema, psoriasis, diabetes)?

Yes (Please Specify)

No

3.1 If you answered Yes to the above question please provide more details.

4. Are you currently taking any medications that may affect your skin or sensitivity (e.g., Accutane, Retinol, antibiotics)?

Yes (Please Specify)

No

4.1 If you answered Yes to the above question please provide more details.

5. Have you had recent sun exposure or used a tanning bed or tanning products in the last 48 hours?

Yes (Please Specify)

No

5.1 Have you had recent sun exposure or used a tanning bed or tanning products in the last 48 hours?

Liability and Waiver

Please read and confirm your acceptance of the following statements by ticking each box:

I understand that all treatments are provided by trained professionals using products and techniques safe for most individuals, but I acknowledge that individual results may vary.

I confirm that I have disclosed all relevant health information and will not hold Glos Beauty Studio responsible for any adverse reactions, injuries, or health issues that may occur as a result of undisclosed medical conditions or sensitivities.

I acknowledge that Glos Beauty Studio is not liable for any damages or loss related to the treatment provided.

Patch Test

Please read and confirm your understanding of the following:

I understand that certain treatments may require a patch test at least 48 hours before the appointment. I acknowledge that it is my responsibility to arrange for this test as advised. I confirm I have completed a patch test.

Treatment Consent

By signing below, you confirm that:

You are not under the influence of any substance that may impair your judgment.
You have provided accurate health information to the best of your knowledge.
You have read, understood, and accepted the terms of this form.

Signature

Date of Signature

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