Policies & Client Forms

Skin By T Aesthetics Client Intake Form

First name

Last name

Phone

Email

Address

Birthday

Month

Day

Year

How did you hear about Skin By T?

Do you currently have or have had any medical conditions I should be aware of? If so, please list below (Ex: Dermatitis, Eczema, Epilepsy, Fever Blisters, etc)

Any known allergies? If yes, please list:

List any medications you take regularly including vitamins, supplements, aspirin, etc.

Any recent surgeries? If yes, please explain:

Are you pregnant or nursing?

Yes

No

Have you ever had a facial treatment before?

Yes

No

If yes, what treatments?

Have you ever been on acne medication? If yes, what drug?

In the last 3 months have you used a Retin-A, Renova, AHA, or Retinol-Vitamin A derivative? If yes, please describe:

Have you recieved Botox, Filler, or any injections in the last 6 months. If yes, which?

How does your skin heal?

Fast

Slow

Scars

Pigments

What are your skin concerns?

What are your skin goals?

What is your current skincare routine?

Do you wear SPF everyday?

Yes

No

Are you interested in a personalized skincare routine?

Yes

No

Maybe

Are you interested in a getting treatments consistently?

Yes

No

Maybe

By signing below, you agree to the following:

I have completed this form truthfully and to the best of my knowledge. I agree to inform the technician of any changes in the above information. I agree to waive all liabilities toward my technician and the employer for any injury or damages incurred due to any misrepresentation of my health history.

Signature

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Appointment Rescheduling & Cancellation Policy

First name

Last name

Date

Month

Day

Year

DEPOSITS

Appointment deposits are non-refundable. Deposits are put down to hold your spot. Your deposit will be deducted from your total at the end of your appointment. If you choose to rebook at your appointment, your deposit will then roll over to your next scheduled time. This will stay on your account file.

RESCHEDULING

Reschedules must be done prior to 48 hours before your scheduled appointment time. If you reschedule within 48 hours, you will lose the deposit and another one must be put down in order to rebook. ($50) - Subject to matter.

CANCELLATIONS

All cancellations will lose deposit. Subject to matter. Same day cancellations/no shows result in a $75 fee. Those are sent via invoice within 24 hours after your missed appointment time.

These policies are in place to cover my time & are strictly enforced. If you have any questions regarding your appointment or need to make a change, text 856-631-6411.

Thank you for understanding

I have read and fully understand the above Appointment Cancellation & Rescheduling Policy and agree to be bound by its terms. I agree to pay the cancellation fee in the event of a missed appointment.

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Photo & Video Release Form

First name

Last name

Date

Month

Day

Year

I hereby grant and give my permission to take, publish, distribute and make use of any and all pictures & videos taken of me to be used in and/or for any lawful promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, press kits, websites, social media sites and other print and digital communications, without payment or any other consideration.

This authorization shall continue indefinitely.

I waive any rights to royalties or other compensation arising or related to the use of the photograph or recording.

I understand that photographs will be taken to track progress & be used for marketing. I fully consent Skin By T to use my photos.

Signature

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