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Cosmotek Consent Form
First Name
Last Name
Email
Phone
Address
Is this Your first facial?
A) Yes
B) No
Describe your main skin issues?
Are you currently taking any medications now?
Do you have any medical conditions?
Are you pregnant?
A) Yes
B) No
Do you have any allergies?
A) Yes
B) No
Would you consider your skin sensitive?
A) Yes
B) No
Are you often out in the sun?
A) Yes
B) No
Do you use tanning beds?
A) Yes
B) No
Are you sensitive to temperature?
A) Yes
B) No
Describe your current skincare routine:
What products are you currently using?
Do you understand the treatments you will receive?
A) Yes
B) No
Do you understand the after care instructions?
A) Yes
B) No
Has our staff member answered all of your questions?
A) Yes
B) No
Is there anything else that you think we should know before starting your appointment?
A) Yes
B) No
By checking the boxes, you confirm that you agree with the following statements:
I understand that I have a risk of contracting virus during the service.
I agree to obey the rules of the salon during my appointment in order to minimize the spread of viruses.
I confirm that I have not been diagnosed with COVID-19 last 14 days.
I am willing to take a temperature check before the services are started. I have not traveled internationally within 14 days.
Book an Appointment
Cancellation Policy
Free cancellation or modification before October 2, 2025, at 2:30 PM PDT. After that, changes to the appointment will result in a charge of $125.00 plus any applicable taxes and fees.
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