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The Lash Insider

Facial Intake and Consent Form

Client Details

Your Medical History

Are you currently under the care of a physician?
Yes
No
Have you experiences any of these health conditions in the past or present?
For the ladies...
Any known allergies?
Have you ever received any Botox or fillers?
Yes
No
Please rate your stress level
None
Low
Medium
High

Tell Us About Your Skin

What skincare products do you use on a daily basis?
Do you experience routine breakouts or acne?
Yes
No
Have you been diagnosed with eczema, psoriasis or rosacea?
Yes
No
Have you received any of these facial hair removal services in the last 7 days?
Do you currently use:
Are you currently using any products that contain:
Have you ever received chemical peels, laser services, or microdermabrasion treatments?
Do you...

Consent

I acknowledge that my skin might experience temporary irritation, tightness, redness or slight swelling which usually dissipates within 72 hours depending on skin sensitivity. 


I acknowledge that if I am allergic to one or more ingredients in the products used, I may experience allergic reactions.


I acknowledge that if I fail to use a minimal sunscreen (SPF 30+), I am more susceptible to sunburn, skin damage & hyperpigmentation. 


I acknowledge that this treatment is strictly elective cosmetic procedure and no medical claims have been expressed or implied.


I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, waxing, and products containing acids that are no part of the recommended take-home regimen for 2-4 weeks following treatment.


I consent (to the best of my knowledge) that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment. I give consent for all future treatments


I release The Lash Insider (TLI) and its staff of any liability associated with any injuries and /or current and future conditions resulting from the skincare procedures or products.

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Book with a TLI CO-OP

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Almighty Aesthetics

Sofia C. | 720.757.8893

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It's important to note: TLI's CO-OP members operate as independent business owners. Each one is licensed, insured and conducting business separately from The Lash Insider. Please note that their pricing and booking policies may differ. For appointments, cancellations, or changes, kindly reach out to each business owner directly.

TLI CO-OP

5025 E. 28th Avenue

Denver, CO 80207​

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