Cosmétique

Client Intake Form

First name

Last name

Phone

Birthday

Photo ID

Country/Region

Address

City

Zip / Postal code

Have you taken Acutane in the last 12 months?

Have you had major surgeries in the last 9 months?

Have you undergone chemotherapy in the last 4-6 months?

Have you been prescribed prednisone/steroid medication in the last 2 months?

Have you discontinued the use of Retin-A in the last 4 weeks?

Have you used lash or brow growth serums in the last 4 weeks?

Have you received botox or filler treatments in the last 2 weeks?

Are you currently pregnant or breast feeding?

Have you ever had a permanent makeup procedure?

I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. The treatments I receive here are voluntary and I release this skin care professional from liability and assume full responsibility thereof.

Signature

Service Agreement

Cosmétique by Alice Paige emphasizes that while we are committed to providing the highest quality of service in color enhancement procedures, we cannot be held responsible for the final results. Various factors, including individual skin conditions, lifestyle choices, and adherence to aftercare instructions, can significantly impact the outcome of the implantation process. Our artists are highly trained and experienced, working diligently to achieve your desired results. However, there are certain variables that may be beyond our control.

We strive to ensure your satisfaction and work collaboratively with you to meet your goals, using the information and conditions presented to us. Your understanding of these factors is crucial in setting realistic expectations for your experience with us.

I understand and agree to these terms regarding the color enhancement procedure.

Signature

Photo Release Form

By signing this release I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public educational setting.

I will be consulted about the use of the photographs or video recording for any purpose other than those listed above.

There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only.

By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.

Signature

In order to ensure the provision of high-quality care within a reasonable timeframe, we have implemented an appointment and cancellation policy.

As appointments are in high demand, canceling your appointment in advance allows us to offer the time slot to another individual seeking timely care. This policy helps us optimize our appointment availability for all clients.

During the appointment booking process, you will be required to make a non refundable deposit, which will be applied as a credit towards your scheduled treatments.

We understand that circumstances may arise requiring you to cancel or reschedule your appointment. To avoid any inconvenience, please notify us at least 72 hours prior to your scheduled appointment. However, if you provide less than 24 hours' notice, a $50 cancellation fee will be charged. After 3 canclations you will no longer be able to book further appointments.

We are more than happy to address any inquiries or concerns you may have regarding our cancellation policy.

I have read and fully understand the above Appointment Cancellation Policy and agree to be bound by its terms. I agree to pay the cancellation fee in the event of a

missed appointment.

Date

Cancelation Policy

Signature