Facial Consent Form | CCC Wellness

Client Information

First name

Last name

Birthday

Month

Day

Year

Your Service Today

About Your Treatment Today

Facials are designed to cleanse, exfoliate, hydrate, and improve the appearance of your skin. Each service is customized to your needs and may include steam, masks, extractions, massage, and professional skincare products.

Possible Temporary Effects

Mild redness or sensitivity
Breakouts from skin detox/purging
Temporary dryness or tightness
Mild flaking if exfoliation is performed

Treatment Goals

What would you like to achieve from today’s treatment?

If you could focus on just one (1) primary skin concern right now, which would you choose?

If you could improve one (1) thing about your skin in the next 3 months, what would it be?

Client Acknowledgement

I have informed my esthetician of all allergies, sensitivities, medical conditions, and medications.

I have not used Accutane (Isotretinoin) in the past 12 months.

I will follow the aftercare instructions provided and avoid tanning, harsh exfoliants, or unprotected sun exposure for at least 48 hours.

I understand that results vary based on skin condition, lifestyle, and home care.

Client Consent

I consent to receiving a facial treatment at CCC Wellness and release my esthetician from liability for any reactions due to undisclosed conditions.

I consent to before/after photos for my treatment record.

I consent to photos for marketing purposes (identity not revealed).

Client Signature

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Date of Signature