Beauty 03 Intake Form
Check all that apply
I have completed this form to the best of my ability and knowledge and agree to inform my practitioner of any changes in the above information. I have been informed of and understand the contraindications to the requested treatments and agree that I do not have any conditions that would make the requested treatment unsuitable . I will inform my practitioner of any discomfort I may experience at anytime during my treatment to allow them to adjust accordingly. I agree to waive all liabilities toward my practitioner & Home Towne Beauty for any injury or damages incurred due to any misrepresentation of my health history.