Aura Consent Forms

Personal / Contact Details

Name

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Date of Birth (dd/mm/yyyy)

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Email Address

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Phone Number

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Postcode

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Address

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Therapist

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Patch Test All of our products undergo extensive testing in line with industry standards and comply with all applicable requirements to ensure that they are safe. However a person's reaction to any product is personal to them and products of any kind can cause allergy or other reactions.
We strongly recommend that all of our customers participate in a skin sensitivity test at least 48 hours prior to the full application of any product, to reduce the risk of an adverse reaction, even if previously used. However, you are responsible for your own safety and it is your decision as to whether you wish to participate in a test or not. Please tick the box applicable to you below, then sign and date this Consultation Form to confirm your understanding of this.
I have undergone an allergy/skin sensitivity test. I do, however, acknowledge that applying any product to the skin or hair is never entirely without risk.

Patch Test Date (dd/mm/yyyy)

Required Medical Information

Consent Form

This form is designed to give you the information you need to make an informed choice as to whether or not to undergo a Chemical peel treatment. If you any have questions please do not hesitate to ask. Although the Chemical peels are effective in most cases, no guarantee can be made that a specific patient will benefit from the treatment.

Possible Side Effects and Complications

Burning and Tingling: You may feel some discomfort when treatment occurs. After 4-5 days you may also experience some peeling.

Headaches: You may experience headaches, nausea, or dizziness during the treatment. Recorded cases of this are rare however.

Hyperpigmentation: This may occur in some areas. We recommend that sunblock in used straight after these chemical peels and during the treatment period to ensure there is no hyperpigmentation.

Client Consent:

By signing below I acknowledge that I have read the informed consent information regarding Chemical Peels. I hereby give consent to have Chemical Peel Treatments performed on me by the therapist. If I know or suspect that I may be pregnant I will inform the therapist prior to the treatment being carried out. I acknowledge that it may be necessary to have more than one Chemical Peel Treatment in certain areas to achieve the desired result.

I also understand that I will not be able to take legal action against Aura if I experience any adverse reactions or be entitled to a refund if I am not happy with the treatment.

NO REFUND ON PACKAGES.

Consent Form: Disclaimer

I understand a patch test is required before I have the above treatment due to a possible reaction to the product or glue. However, I am prepared to take full responsibility with this disclaimer and will not pursue any action against the therapist or the salon should there be any reaction what so ever. No refunds will be given.

Please accept Disclaimer.

Have you had: waxing, laser treatments or electrolysis in the last 48 hours?	Yes No
Have you had any extreme heat or sun exposure in the last 2 weeks?	Yes No
Are you wearing contact lenses?	Yes No
Are you currently seeing a medical professional or anyone else about your Skin?	Yes No
Do you have any allergies or skin sensitive or other health problems?	Yes No
Do you use any topical medicine or prescription medications? (Including: Retin-A, Hydroquinone, Benzoyl Peroxide, Antibiotics, Metrogel, Efudex, Cortisone etc)	Yes No


Laser Skin Resurfacing	Yes No	Dermal Fillers	Yes No
Semi-Permanent Make-Up	Yes No	Plastic Surgery	Yes No
Chemical Peels	Yes No