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Please complete the following forms AFTER you have booked your appointment.

We are committed to taking extra precautions. This health screening is to ensure your understanding of health and wellness as it relates to sanitation and disinfecting practices. As recommended by the CDC all service providers at Beauty Regime will continue to stay home and/or reschedule your appointment if we fall ill or are showing any of the signs/symptoms of communicable illness.  Please complete the following health screening.

Common symptoms of communicable illness include, but not limited to:


  • Cough or dry cough

  • Shortness of breath or difficulty breathing

  • Fatigue/tiredness

  • Sore throat

  • Fever or chills

  • Muscle or body aches/pain

  • Headache

  • New loss of taste or smell

  • Sore throat

  • Congestion or runny nose

  • Nausea or vomiting

  • Diarrhea

Does you or anyone in your household currently have or have experienced any of the symptoms previously stated in this form, now or within the last 14 days?
Have you or anyone in your household traveled outside of the country or traveled to another city or state within the last 30 days?
Have you had a fever in the last 24 hours of 100°F or above?

Communicable diseases are highly contagious virus that spread from person to person. In addition to long-held and explicit sanitation measures, this business has always adhered to, new preventative measures have been put in place to further reduce the spread of novel viruses. However, these best practices still offer no guarantee regarding your potential risk of being infected.


Consent for Treatment
I understand that, because esthetics involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission. By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner/business from any claims related thereto. I give my consent to receive treatment from this practitioner

Your Health Screening Form submission was successful!

Please complete the Informed Consent For Treatment form below.


Please complete and submit this form to be prompted to schedule your service. 

PRECAUTIONS (Please read carefully):

Your participation in your skincare treatments will determine the outcome. It is important that you strictly adhere to your home care regimen that your aesthetician has recommended. 

No guarantee is expressed or implied as to the precise results, peeling times, or discomfort. 

During the treatment, you may experience some tightening of the skin, which may last for several days. 

For most patients, flaking begins within 48 hours. It is impossible to pre-determine how much peeling will occur. The shedding process usually subsides within 5-7 days. 

Depending on the treatment performed and your skin quality, the following reactions may occur in some patients: 

  1. Prolonged redness, irritation & flakiness

  2. Dryness & sensitivity

  3. Severe allergic reactions in rare instances 

Please select all that apply:
Skin Conditons (Please select all that apply):

Thank you for submitting your form!

Informed Consent Form
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