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Your Waiver / Intake Form

Welcome to Sexy Visage Makeup Artistry and Spa! To ensure your service is perfectly tailored, please complete our Client Consultation Form. This vital step allows us to understand your skin, goals, and any sensitivities, enabling us to create the best treatment plan and use the ideal products and techniques for a successful result. Please be honest and open—the more details you share, the better we can customize your service. Everything you share is 100% confidential and used only for planning and executing your service. We look forward to seeing you!

First name

Last name

Email

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

How did you hear about us?

Birthday

Month

Day

Year

Emergency Contact Info

What are your short term & long term goals for your skin?

Are you pregnant or breastfeeding?

YES

NO

Do you have Diabetes?

YES

NO

Do you have any skin conditions?

YES

NO

Do you work outdoors?

YES

NO

Do you have a cardiovascular or thyroid problems?

YES

NO

Do you have a history of smoking or using tobacco products?

YES

NO

Do you have trouble with wounds healing?

YES

NO

Have you ever been diagnosed with Cancer?

YES

NO

If you answered "yes" to anything above, please explain.

Do you exercise regularly?

Yes

NO

Do you use SPF?

Yes

NO

Sometimes

Any other conditions, disease or disorders?

My skin is...

Resilient

Reactive

Sensitive

I dont know

Acne Stage

Stage 1(This is the most common and least severe form of acne.) typically hormonal.

Stage 2 (see a mix of non-inflammatory and inflammatory lesions.)

Stage 3 (Numerous papules and pustules, along with the development of large, hard, painful lumps deep beneath the surface of the skin.)

Stage 4 (most serious form. Numerous large, painful cysts and nodules. Large, pus-filled, painful lumps deep beneath the skin . Hot to touch and painful)

I dont get acne

Fine lines & Wrinkle Stage:

Stage 1 (None)

Stage 2 (Wrinkles in motion)

Stage 3 (Wrinkles at rest)

Stage 4 (Mostly wrinkles)

Do you use any acne medication? If yes, please explain.

Do you use any prescription acne medication (Accutane, Retin-A, etc)

Are you using any AHA, BHA or acids?

Have you had collagen, Botox, fillers in the past 6 months? If yes, please explain

Do you have any allergies? (Food, cosmetics, plants, latex, ect) please explain.

Have you seen a Dermatologist in the past 6 months? if yes please explain.

What is your skincare routine?(please list name/brand)

Liability Waiver

Welcome! This form ensures you are fully informed and comfortable with the facial service you are receiving today. Your signature confirms your voluntary consent and understanding of the key details and disclosures outlined below. Please read carefully.

Please type your name to acknowledge that you have viewed the Liability Waiver

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