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Facials Release Form
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Name
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First
Last
Phone
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Medical Questions
This section will cover your medical history. Please make sure to answer these questions truthfully.
Do you have any Flu-related symptoms?
*
Yes
No
Symptoms might include a fever, shortness of breath, loss of taste, continuous cough.
Do you suffer from any of the following?
Previous allergy to skin treatments or skin care products, or make up
Are you currently on any medication
Dermatitis, eczema, psoriasis
Acne
Shingles
Impetigo
Scabies
Ringworm
Do you have a skincare routine
Do you protect your skin with a moisturiser containing SPF
Do you use soap on your face
Do you have any allergies?
Signing
Waive
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I Agree
TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Therapist and the Salon from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from my facial, whether caused by the negligence or fault of either the Therapist or the Salon, or otherwise.
Questions
*
I Agree
I acknowledge that I have been given adequate opportunity to read and understand this document, that any and all of my questions have been answered, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Therapist and the Salon.
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