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Consent Form

Please complete this consent form before your Facial Treatment appointment. Once you sign, a copy is emailed to you and to Gemma automatically.

Your details

Facial Treatment — treatment information & disclaimer

Our facials cleanse, exfoliate, extract, treat and hydrate the skin using professional products, and may include steam, massage and a mask. Facials are a non-invasive treatment and results vary between individuals. The treatment is generally well tolerated and non-irritating.

Occasionally the skin may feel sensitive or appear slightly red immediately afterwards; this usually settles within a few hours. Rarely, a reaction to a product or mild breakout can occur. Please disclose any allergies, skin conditions or recent treatments before we begin so we can tailor the facial safely.

A non-refundable deposit is required to secure your appointment. The balance is payable at your appointment. Deposits and booking fees are non-refundable unless agreed with the practitioner.

Medical screening

Please answer honestly — this keeps your treatment safe. Add detail in the notes where relevant.

1. Are you pregnant, breastfeeding, or trying to get pregnant?
2. Do you have any medical conditions? If yes, please give details.
3. Are you taking any medication (including blood thinners such as Warfarin/Aspirin)? If yes, please list.
4. Do you have any allergies, or have you ever had anaphylaxis? If yes, please give details.
5. Do you have any skin or neuromuscular disorders?
6. Do you have diabetes, an autoimmune disease, or a bleeding/clotting disorder?
7. Do you have a history of keloid or hypertrophic (raised) scarring?
8. Do you have any active infection, cold sores, or inflammation at the treatment area?
9. Have you had this or a similar treatment before? If so, did you have any problems?
10. What are your aims and motivations for the treatment / desired outcome? Please give details.
11. Is there any other medical or social history we should know? Please give full details.
12. Do you understand the information provided and feel it is sufficient for you to consent?
13. Has your consent been given freely?

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