Consent Form

CLIENT INFORMATION

Full Name:

Phone Number:

Email Address:

Date of Birth:

MEDICAL & SKIN HISTORY

List all allergies:

List all current medications:

Have you used Accutane in the last 12 months?

Yes

Have you used retinol or exfoliating acids in the last 72 hours?

Yes

Recent cosmetic procedures?

Botox

laser

waxing

microneedling

TREATMENT CONSENT

Services are non medical.

Redness, irritation, dryness, and sensitivity may occur

Results vary by individual.

Multiple treatments may be needed.

I must follow aftercare instructions.

CHEMICAL PEEL RISK ACKNOWLEDGMENT

Redness

Tingling/Burning

Peeling/Flaking

Temporary pigmentation changes

Breakouts

Dryness/Tightness

Increased sun sensitivity

Rare: blistering or hyperpigmentation

I acknowledge:

I will avoid sun exposure and wear SPF daily.

I will not pick or peel my skin

I will avoid heat/sweating for 24–48 hrs

I will avoid retinoids, scrubs, acids temporarily.

I will use only recommended aftercare products.

LIABILITY RELEASE

I am receiving this treatment voluntarily

I understand all risks.

I have disclosed all medical conditions

Royalty Lush Beauty Bar LLC is not responsible for reactions caused by

By signing, I agree:

No results are guaranteed.

PHOTO CONSENT (Optional)

Allow before/after photos for documentation

Allow use for social media

Do NOT allow photos

By signing, I agree:

Client Name:

Date:

Aesthetician Signature:

Untitled(Required)

By marking this option, you accept that Royalty Lush Beauty Bar holds no responsibility for any incidents.

ROYALTY LUSH BEAUTY BAR LLC DIGITAL CONSENT FORM — GENERAL TREATMENT + CHEMICAL PEEL

CLIENT INFORMATION

No results are guaranteed.

ROYALTY LUSH BEAUTY BAR LLC
DIGITAL CONSENT FORM — GENERAL TREATMENT + CHEMICAL PEEL