Example Contract Do you take any of the following? * Accutane Retin-A Benzoyl Peroxide Glycolic Acid Lactic Acid Salicylic Acid Other Do you currently have or have ever been treated for any of the following? * Hypertension HIV Herpes Simplex Skin Disease Diabetes Cancer Hormone Therapy Other Do you have any allergies? * Do you have any metal implants in your body? * Are you pregnant or breastfeeding? * What is your current skincare regimine/routine? * Cleanse Tone Eye Cream / Gel Exfoliate Serum Moisturize Other By e-signing below, you agree to the following: I have completed this form to the best of my ability and knowledge and agree to inform my esthetician of any changes to the information listed on all the pages of this client intake form. I have been informed of and understand the contraindication to the requested treatments and agree that I do not have any condition(s) that would make the requested treatment unsuitable. I will inform my esthetician of any discomfort I may experience at any time during my treatment to allow them to adjust accordingly. I agree to waive all liabilities toward my esthetician and Adiuvo Aesthetics for any injury or damages incurred due to my misrepresentation of my health history. E-Signature * First Name Last Name Thank you!
