Personal Details



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    Medical History
    Are you currently or within the last year under a physician’s care? *


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    Are you currently being seen by a physician for a medical condition that is not completely diagnosed? *


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    Are You Currently Taking any Medication? *


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    Are you taking any oral medications, if so please select below?


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    Are you Pregnant or trying to become pregnant?

    Do you currently have metal implants or a pacemaker?

    Allergies
    Have you ever had an allergic reaction to any of the following? Please check all that apply and describe the reaction you experienced


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    Skin Care History
    Are you currently under the care of a dermatologist? *


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    Do you have any special skin problems pertaining to your face or body? *


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    Do you have a tendency to redness? *

    Have you ever had laser hair removal? *

    Please agree to the terms and conditions below
    I certify that the preceding medical, personal and skin history statements are true and correct.
    I accept that any treatment I have is taken at my own risk. I certify that I have read and have completed the above to the best of my knowledge. I understand that failure to disclose information requested above may result in adverse side effects, unknown because of this to which I accept full liability/responsibility. I am aware that it is my responsibility to inform the Therapist of my current and ongoing medical or health conditions and it is essential for the caregiver to execute appropriate treatment procedures. I acknowledge the possible side effects of any beauty procedure.
    I understand that indulgence Beauty Salon reserves the right to charge for appointments cancelled or broken without 24 hours’ notice.
    Accept