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Informed Consent, Medical History & Release Form

"*" indicates required fields

How Did You Hear About Us?*
What are your skincare challenges?*
Please check one of the following skin tones and reactions:

Have you ever had a facial or skin treatment before?*
What skincare products do you currently use?

If you are seeking corrective treatments please detail the SPECIFIC products (BRAND & PRODUCT TYPE/NAME) you are currently using so I can best answer any questions on ingredients and help you meet your skin care goals.
Do you/have you used Retin-A, Accutane, Glycolic Acid, Lactic Acid, Mandelic Acid, Retinol, or other Vitamin A derivitives?
Have you received any of these hair removal services in the last 30 days?
Have you ever received chemical peels, laser services, or microdermabrasion treatments?
Have you received any Botox, Juvederm, or other dermal fillers in the last two weeks?

Your Health

Have you experienced any of these health conditions in the past or present?*
Do you take any of the following health supplements*
Have you used or been prescribed any medications (topical or oral) for acne / acne control?
Are you a smoker?
Have you ever experienced claustrophobia?
Please rate your stress level

Female Clients

Are you taking birth control?
Any Menopause Issues?
Are you undergoing hormone replacement therapy?

Male Clients

What is your current shaving system?*
Do you experience irritation from shaving?*
I understand that I must inform Ombré Studio Sydney of any changes to my medical history*
I have had a consultation where I have been advised of the benefits and potential side effects of treatment for hair reduction using laser.*
I have been advised of the following:*
In relation to my initial, and all subsequent treatments, I advise that:
Photography and Videography Release Consent*
Our insurance company requires "Before and After" photos/ videos be taken and kept on file. We would like your permission to use these photos/videos for advertising for example, in portfolios, online and in print ads, etc. Your consent is necessary regarding this. Please SELECT if you would like your photos/videos used or not used in advertising.