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)

Medical/Lifestyle History

Treatment Consent

I have been informed that my skin may be dry, itchy and sensitive and peel after the treatment. This may occur for up to 5-7 days.

I fully realise that I may need a course of treatment to achieve my desired results. I have been advised to wear SPF 50 sun cream to avoid pigmentation.

I am over 18 years old and do not have any of the above contraindications. I consent for an Aura therapist to carry out the treatment at my risk. I understand that I will not claim insurance or take legal action against Aura adverse reactions from the treatment.

NO REFUND GIVEN ON ANY PAGKAGES

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 salon should there be any reaction what so ever. No refunds will be given.

Please accept Disclaimer.

Ultra Sensitive Skin	Yes No	Wear a Pacemaker	Yes No
Pulmonary Embolism	Yes No	Blood Clots	Yes No
Pregnancy	Yes No	Smoking	Yes No
Lupus	Yes No	Taking Antibiotics	Yes No
Hirsutism	Yes No	High/Low Blood Pressure	Yes No
Leg Ulcer or Phlebitis	Yes No	Taking Blood Thinners	Yes No
Recent Scarring	Yes No	Medical Peels	Yes No
Hirsutism	Yes No	HIV / AIDS	Yes No
Plastic Surgery	Yes No	Skin Allergies	Yes No
Steroids	Yes No	Laser Skin Resurfacing	Yes No
Cancer	Yes No	Scars that turn Brown / White	Yes No
Transplant Anti-Rejection Drugs	Yes No	Rheumatoid Arthritis / Gold Therapy	Yes No
Semi-Permanent Makeup in the last 6 months	Yes No	Use of Roaccutane / Retin-A in last 6 months	Yes No
Holiday in the last 3 months	Yes No	Extreme sun exposure in the last 2 weeks	Yes No
Psoriasis / Vitiligo	Yes No	Wears contact lenses	Yes No
Waxing / Laser Electrolysis on the face in the last 48 hours	Yes No	Coloured recently	Yes No
Allergy to Aspirin or AHS's	Yes No	Diabetes	Yes No
Any Skin Disorders or Infection	Yes No

Microneedling

Personal / Contact Details

Medical/Lifestyle History