Client Forms

1. Client Information

Basic details and how we can reach you.

Full Legal Name * Preferred Name

Date of Birth * Pronouns

Phone Number * Email Address *

Street Address

Emergency Contact Relationship Emergency Phone

How did you hear about us?

Referral Website Social media Search engine Advertisement Other

If other or referral, please tell us who or where:

2. Health History

Please check any conditions that apply to you. This ensures safe treatment selection and protects against contraindications.

Please provide additional details, if applicable:

Are you currently under the care of a physician or medical provider for any condition? If yes, please explain:

Have you had, or are you undergoing, oncology/cancer treatments? Are you currently pregnant or nursing?

3. Medications and Allergies

Disclose all medications, supplements, and topicals to avoid contraindications with active ingredients.

Current medications, supplements, or topical products:

Known allergies or sensitivities (check all that apply)

No known allergies Fragrance Latex Adhesives Retinoids Aspirin / salicylic acid Other

If other allergy, please list:

Have you ever experienced an allergic reaction to a cosmetic or skincare product? If yes, please describe:

4. Skin History

Your skin characteristics, primary concerns, and current regimen.

How would you describe your skin?

Current skincare routine and products

Cleanser: Toner / Essence:

Serum / Treatment: Moisturizer:

Sunscreen: Other products:

Have you used any of the following within the past 7 days? (check all that apply)

Retinol or prescription retinoids AHAs/BHAs or exfoliating acids Benzoyl peroxide Scrubs or exfoliating devices At-home chemical peels Acne medication Self-tanner Waxing, threading, or depilatory products None of the above

Retinol/Vitamin A in past 2 weeks? * Last Dermaplane treatment? * Botox/fillers in last 2 weeks? *

Date of most recent facial, peel, waxing, laser, microneedling, injectables, or other cosmetic treatment:

5. Lifestyle and Sun Exposure

Environmental exposure and daily habits affect skin barrier resilience and healing time.

How often do you use sunscreen? Do you smoke or use nicotine products?

Recent sun exposure, sunburn, or tanning-bed use: If yes, date/details:

Typical water intake: Other relevant lifestyle information:

6. Treatment Goals

Help Sunny tailor your service to your priorities and comfort.

What would you like to address during your appointment? What are your treatment goals or desired results? Are there any products, ingredients, or techniques you do NOT want used?

7. Contraindications and Safety Confirmation

Please notify your esthetician before treatment if you have:

Open wounds, active infection, severe irritation, or a contagious skin condition
A recent sunburn
Recent cosmetic injections, laser treatment, surgery, or strong exfoliation
Any new medication or medical diagnosis
An active cold sore or unexplained rash
Known allergies or sensitivities

Your esthetician may modify, postpone, or decline a service when necessary for your safety.

I have reviewed the contraindications notice above and confirm that I will notify Sunny prior to treatment if any apply. *

8. Consent to Treatment

I understand that esthetic services may cause temporary redness, sensitivity, dryness, irritation, swelling, breakouts, bruising, or other reactions. I understand that results vary and cannot be guaranteed.

I agree to provide complete and accurate health information and to inform my esthetician of any changes before future treatments. I understand that failure to disclose relevant information may increase the risk of an adverse reaction.

I have had the opportunity to ask questions and voluntarily consent to the recommended esthetic services.

Client Typed Signature * Date *

Parent / Guardian Signature (if client is a minor under 18)

Parent/Guardian Signature: Relationship to Client: Date:

9. Photo Consent

Please select your photo consent preference:

I consent to before-and-after photographs for treatment documentation only (private client record). I consent to photographs being used anonymously for educational or marketing purposes (social media/portfolio). I do not consent to photographs being taken or used.

Client Initials *

10. Privacy and Communication Consent

I authorize the establishment to contact me regarding appointments, aftercare, scheduling, and relevant services.

Preferred contact method (check all that apply)

Phone Email Text message

I understand that my personal and health information will be handled confidentially, subject to applicable privacy laws and business policies.

Electronic Signature Acknowledgment: I certify that the health information provided above is complete and accurate to the best of my knowledge. I understand that esthetic treatments may carry contraindications and I agree to notify Sunny of any changes in my medical status or skincare regimen. I agree that my typed name serves as my electronic signature for this intake. *

Privacy Authorization Signature Date

New Client Intake & Health Screening