Rosie's Esthetics

Client Intake, Health History & Informed Consent

Welcome to Rosie Esthetics!

Thank you for choosing us for your skincare and beauty services. This confidential form helps us provide safe, customized treatments based on your skin type, concerns, and health history. Please complete all sections before your appointment.

Client Information

Skin & Beauty Goals

What are your primary skincare concerns? (Select all that apply)

Health History

Please answer honestly. This information helps us provide safe and effective treatments.

Are you currently experiencing or have you recently experienced any of the following?

Have you used any of the following within the past 12 months?

 Have you recently had any of the following?

Services Requested

Please check all that apply.

Informed Consent

I understand that esthetic treatments are intended to improve the appearance and condition of the skin but that no guarantees or warranties have been made regarding specific results.

I understand that temporary redness, irritation, dryness, swelling, tenderness, bruising, sensitivity, peeling, itching, breakouts, or allergic reactions may occur following treatment.

I agree to disclose all medical conditions, medications, allergies, and recent cosmetic procedures. I understand that failure to provide accurate information may increase the risk of complications.

I understand that Rosie's Esthetics reserves the right to refuse or discontinue treatment if a service is considered unsafe.

Treatment-Specific Acknowledgments

Waxing

I understand waxing may cause temporary redness, sensitivity, bruising, lifting of the skin, or irritation. I confirm that I am not using medications or products that make waxing unsafe unless discussed beforehand.

Hydrafacial

I understand temporary redness, tightness, mild peeling, or sensitivity may occur.

Nano Needling

I understand results vary and multiple treatments may be recommended. Temporary redness and sensitivity are common.

Microdermabrasion

I understand that temporary redness, dryness, peeling, or mild irritation may occur following treatment.

Lash Lift & Brow Lamination

I understand there is a possibility of irritation or allergic reaction despite appropriate precautions. I agree to follow all aftercare instructions.

Aftercare Agreement

I understand that following my esthetician’s aftercare instructions is important for achieving the best possible results.

I understand that failure to follow aftercare instructions may reduce treatment effectiveness or increase the risk of irritation or complications.

Release of Liability

I voluntarily consent to receive esthetic services from Rosie's Esthetics.

I understand that while reasonable care will be exercised, no treatment is entirely free from risk.

To the fullest extent permitted by Alabama law, I release and hold harmless Rosie's Esthetics, its owner, employees, contractors, and representatives from claims arising from known or disclosed risks associated with the services provided, except where caused by gross negligence or willful misconduct.

Photography Authorization

I authorize Rosie's Esthetics to take before-and-after photographs and use them for educational and marketing purposes. My identity will not be disclosed without my permission

Appointment & Cancellation Policy

I understand appointments are reserved specifically for me.

I agree to provide at least 24 hours’ notice for cancellations or rescheduling whenever possible.

I understand that missed appointments or late cancellations may be subject to applicable fees in accordance with Rosie Esthetics’ posted policies.

Electronic Signature Consent

By signing this document, I acknowledge the inherent risks and voluntarily assume full responsibility for any injury, damage, or loss that may result from my participation. I hereby waive and release the business, its owners, and its staff from any and all liability, past, present, and future, relating to the services provided.