Client Consultation Form

Full Name *
Full Name
Would you like to receive educational blogs and promotions via email? *
Are you happy for us to share your before and afters on social media? *
1. Have you had any facial surgery/botox/fillers in the last 3 months? *
2. Have you any of the following health conditions, past or present?
5. Do you smoke? *
6. Are you on a specific diet? *
7. Do you have metal implants?
8. Do you have any specific skin conditions? *
9. Are you regularly exposed to UV for long periods of time? *
10. Have you ever used a solarium bed? Y
11. Have you had high amounts of sun exposure in the last 2 weeks? *
12. Do you experience oily “shine” during the day? *
13. Do you believe your skin to be sensitive? *
14. Do you experience irregular or painful periods? *
15. Do you suffer from Endometriosis or PCOS? *
16. Do you have any allergies or food intolerances? *
17. Are you currently pregnant or breast feeding? *
22. Do you suffer from Eczema, Psoriasis or Dermatitis? *
23. Do you suffer from digestive issues, constipation or diarrhoea? *
24. Are you currently working with a Naturopath or Chinese Dr? *
25. Are you exposed to high amounts of stress? *
Disclaimer *
I give my consent to receive treatments from SJM Skin Aesthetics. I understand that prior to every treatment, I will advise my therapist of any new medications, skin conditions or any other bodily changes, eg. Pregnancy, other skin treatments or new products. I acknowledge that I will not use prescriptive creams + topical antibiotics prior to the treatment, and not have botox or fillers for two weeks before and two weeks after treatment. I understand that I should follow the therapist’s aftercare advice. This may include recommended skincare products, advising SJM Skin Aesthetics of any concerns or changes immediately after the treatment, seek the advice of my Dr if I experience any ill effects and use sun protection at least SPF 15+ on exposed areas being treated. For 24 hours after my treatment I also agree that I will not: undertake excessive or vigorous physical activity, avoid direct sun exposure, and use approved topical skincare as recommended by my therapist. I hereby declare that I have read and fully understand the above information. I have been informed about specific treatments and its possible side effects and all of my questions have been addressed in a satisfactory manner. No guarantees have been made in regard to final results or lessened potential risks. I agree to proceed with treatment knowing all of the associated risks and confirm and agree that any treatment is at my own risk. *Cancellation Policy* We request your credit card details as security to make your booking. No amount is charged to the card unless there is a late cancellation or reschedule (this is anytime after 24 hours of receiving your reminder text). If this occurs, a $50 cancellation fee will be charged or $100 for appointments over 1.5 hours. I agree to this Cancellation Policy and understand I will be charged for late (within 24 hours) cancellation or rescheduling of my appointment.