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BEAUTY BOX STUDIOS LLC

Client Intake + Informed Consent (Facials & Waxing) 2297 Renaissance Dr, Suite C • Las Vegas, NV 89119 • 702‑934‑8886

A) CLIENT INFORMATION

Date of birth
Month
Day
Year

B) SERVICE(S) REQUESTED

Check all that apply

C) SKIN GOALS + PROFILE

Main goal (Choose 1)
Glow / dullness
Pores / congestion
Acne (inflamed or closed comedones)
Dark spots / hyperpigmentation
Anti‑aging / firming
Hydration / sensitivity
Other
Skin type (Your perception)
Normal
Dry
Combination
Oily
Sensitive
Note sure
Skin tone: Fitzpatrick
Current products/actives (check all that apply):

D) HEALTH / HISTORY (CHECK YES/NO)

Waxing (if applicable):

E) INFORMED CONSENT

1) What I’m consenting to. I understand the services provided are cosmetic (not medical): facials and/or waxing. My provider may adjust the protocol based on my intake, skin condition, and professional judgment. I may request to pause or stop the service at any time.


2) Possible risks & side effects. I understand that cosmetic services may cause temporary effects including (but not limited to) redness, sensitivity, dryness, peeling/flaking, swelling, bruising, irritation, allergic reaction, temporary breakouts/purging, and post‑inflammatory hyperpigmentation or hypopigmentation. Waxing may also cause irritation,

folliculitis, ingrown hairs, bruising, superficial burns, skin lifting, scabbing, or abrasions (risk increases with recent retinoid use, isotretinoin, strong exfoliation, or sensitized skin).


3) Hygiene & safety. I understand Beauty Box Studios follows professional sanitation practices. However, any skin service carries a small but possible risk of infection.


4) Accurate information. I confirm the information I provided is complete and truthful (health conditions, medications, allergies, and recent treatments). I understand that withholding information increases risk and may affect outcomes.


5) No guaranteed results. I understand results vary and are not guaranteed. Outcomes depend on my skin, consistency, home care, hormones, lifestyle, and following recommendations.


6) Aftercare. I agree to follow post‑treatment instructions. If I experience severe pain, significant swelling, blistering, warmth, pus, or fever, I will contact Beauty Box Studios and seek medical attention as needed.


7) Release of liability (to the fullest extent permitted by Nevada law). To the maximum extent allowed by the laws of the State of Nevada, I release and hold harmless Beauty Box Studios LLC, its owner, employees, and independent contractors from claims for injury or damages arising from ordinary and inherent risks of cosmetic services, except to the extent caused by willful misconduct or gross negligence.


8) Contraindications & refusal of service. I understand my provider may postpone or refuse a service if it is not safe for my skin or if contraindications are present. For waxing, services may be declined when there is recent isotretinoin use, active sunburn, compromised skin, or strong retinoid/acid use on the area.


9) Minors. Clients under 18 require a parent/legal guardian signature.

F) PHOTO & VIDEO AUTHORIZATION

Beauty Box Studios may take before/during/after photos or video for treatment documentation. Please select how (if at all) images may be used:
Internal chart only: permitted only for my client record.
Marketing (non‑identifying): permitted for website/social/portfolio without showing my face or personal details.
Marketing (face visible): permitted for website/social/portfolio; I understand my face may be visible.
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