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Client Consultation Form

Please complete this form on request prior to your appointment.

Date

Full Name

Email

Phone Number

Address

Date of Birth

GP Practice

Allergies/ Medication

Contra-Indications * Required

Eye Infection

Hypersensitive Skin

Active Acne

Undiagnosed Lump

Infectious Skin Condition

Recent Surgery/ Injections

Undergoing Cancer Treatment

Epilepsy/ Spasms

Diabetic

Wear Contact Lenses

Watery/ Sensitive Eyes

Issues with treatments in the past

Inflammation of the Skin

Recent scarring in treatment area

Open wounds in treatment area

Fresh Bruising

Eczema/ Psoriasis

Sunburn

Active Cold Sore

Had/Have Covid-19

Loss of Skin Sensitivity

Pregnancy

None of the above

Disclaimer - I consent to receiving treatment and agree to disclose any relevant medical history and conditions which may effect the treatment. I also agree to follow any advice and aftercare given following the treatment. I have read and agree to all policies (available to read on FAQs tab at the bottom of the page)

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This form must be completed for any beauty service booked at Evolve Beauty By Caitlin.

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