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Get Rejuvenation Spa & Laser Services Airbrush Tanning Consultation & Waiver Form

Com Airbrush Tanning Consultation Waiver Form Name Email Address Phone Do you prefer we contact you via Phone Text Email D/O/B Age Occupation Male Female How Did You Find Our Salon Referred By Have you ever used a self-tanner with a bronzer List products Have you ever had any skin reactions from a self-tanner Please describe Have you ever been professionally sprayed with a sunless tanning solution Yes If yes please circle. Rejuvenation Spa Laser Services 609 Route 109 Suite L2 W* Babylon NY 11704 Phone 631-816-1718 Fax 360-294-6873 Email RejuvenationSpaLaserServices yahoo. Magic Tan/Vera Spa Do you have allergies Yes / No* Mystic Tan No Professional Airbrush Tan Other If so are any related to Dihydroxyacetone DHA Yes Do you have any skin conditions that may be of concern Yes / No List Do you wear contact lenses Are you pregnant If yes gets doctors note. If yes contact lenses should be removed before spraying. We always recommend asking your doctor and bring in an approval note. What skin type do you have Circle One 1. Always burn never tan 2. Burn but still can achieve a tan How often do you use a moisturizer Everyday 3. Tan easily rarely burn Sometimes Did you exfoliate your skin before your visit Do you have any lotions or creams on now Never Skin Conditions Skin Dry Exercise Oily Daily Combination Acne Prone Once a week Sensitive 2-3 Weekly Skin Tone Warm Neutral Cool 4-6 Weekly I understand that I am responsible for all jewelry clothing and accessories I wear before after my airbrush tanning application* I understand and do not hold anyone but myself responsible for any of these items. I assume responsibility for any kind of allergic reaction I might have to this formula* I understand that I am doing this sunless tanning treatment at my own risk. Magic Tan/Vera Spa Do you have allergies Yes / No* Mystic Tan No Professional Airbrush Tan Other If so are any related to Dihydroxyacetone DHA Yes Do you have any skin conditions that may be of concern Yes / No List Do you wear contact lenses Are you pregnant If yes gets doctors note. If yes contact lenses should be removed before spraying. We always recommend asking your doctor and bring in an approval note. If yes contact lenses should be removed before spraying. We always recommend asking your doctor and bring in an approval note. What skin type do you have Circle One 1. Always burn never tan 2. Burn but still can achieve a tan How often do you use a moisturizer Everyday 3. What skin type do you have Circle One 1. Always burn never tan 2. Burn but still can achieve a tan How often do you use a moisturizer Everyday 3. Tan easily rarely burn Sometimes Did you exfoliate your skin before your visit Do you have any lotions or creams on now Never Skin Conditions Skin Dry Exercise Oily Daily Combination Acne Prone Once a week Sensitive 2-3 Weekly Skin Tone Warm Neutral Cool 4-6 Weekly I understand that I am responsible for all jewelry clothing and accessories I wear before after my airbrush tanning application* I understand and do not hold anyone but myself responsible for any of these items. .

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