Consent form for Facial -Ivy Wellness Center

Consent form for Facial

Full Name

Appointment Date

Phone number

What type of skin do you have?

Do you have any skin disease?

Do you have acne?

Do you take any medications now?

Do you have allergies to creams, oils or medications?

Facial procedure: makeup removal, facial cleansing & exfoliation, steam vapor, blackhead extraction, anti-inflammatory mask, hydrating mask & sunscreen optional.

Facial cleansing benefits: eliminates impurities & dead skin, open pours, removes blackheads, softens & hydrates skin, delays appearance of wrinkles.

Recommendations after facial cleansing: avoid exposure to sun, computers, saunas or exercise that makes you sweat for the rest of the day. If you go out in the sun apply sunscreen.

* In case you don't want to use sunscreen: during the following 3 days avoid direct sun and prolonged exposure to screens, to avoid irritation, freckles or spots caused by exposure to light after the facial.

We apply sunscreen after the facial to protect your face from the sun or blue light from computers. Do you want us to apply sunscreen after the facial?

Consent for photos of face before, during & after facial: Health Dept. requires us to take a photo of the patient's face before, during & after facial to record a medical history. After 30 days we delete the photos.

Are you agree with taking 3 photos of your face?

The client declares that all the above info is true & declares that he/she doesn’t have any skin condition that could irritate the face with a facial cleansing.

Your Signature