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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Medical & Contra-indications

CONSENT

I understand that not using the prescribed products for homecare recommendations section may result in a less effective treatment.

I have been advised to avoid injectables for 14 days prior to my treatment. I am aged over 18 or have parental consent.

I agree to inform the clinic immediately if there is any adverse skin reactions.

My signature is confirms that I have read the details under each section and agreed to receive treatment as advised in my consultation form.

COURSE CONSENT

I certify that I have read the entire informed consent and agree to all its provisions. I certify that I have had the opportunity to ask questions and these questions have been answered to my satisfaction I fully understand the treatments conditions and procedure.

I agree to pay for the above mentioned services and understand that there will be no refunds for any performed services.

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.

Diabetes	Yes No	Eczema / Psoriasis / Dermatitis	Yes No
Active Acne	Yes No	Keloid Scars	Yes No
Pregnancy	Yes No	Skin Pigmentation	Yes No
Asthma	Yes No	Skin Cancer	Yes No
Telangiectasia (blood vessels)	Yes No	Sensitive Skin	Yes No
Allergies	Yes No

Naturapeel

Personal / Contact Details

Medical & Contra-indications