Run Spa Advanced Treatment Consent Log — Free

Client and Appointment Details

Client Name (required)

Appointment Date (required)

Provider Name (required)

Treatment Location

Treatment Requested

Treatment Type (required)

Describe the specific treatment or product to be used (required)

Chemical Peel Strength (required)

Treatment Area (required)

Contraindication Screening

Are you pregnant or nursing? (required)

Have you used isotretinoin (Accutane) within the last 6 months? (required)

Have you had recent waxing, laser, retinoid use, or exfoliation on the treatment area? (required)

Current skin conditions or concerns

Known allergies or sensitivities relevant to treatment

Include only product, ingredient, or topical sensitivities relevant to the planned service.

Informed Consent and Acknowledgment

I understand the possible risks, including redness, irritation, peeling, temporary discoloration, sensitivity, and the possibility of an adverse reaction. (required)

Yes No N/A

I understand and agree to follow the aftercare instructions provided by the provider. (required)

Yes No N/A

Alternative treatments or deferral options were discussed with me. (required)

Yes No N/A

I had the opportunity to ask questions and received satisfactory answers. (required)

Yes No N/A

I consent to receive the selected treatment today. (required)

Yes No N/A

Signature and Submission

Client Signature (required)

Signature Date (required)

Provider Notes

Record any treatment-specific notes, deferrals, or follow-up instructions. Avoid unnecessary PII.

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Email (required)

Your name (optional)

Run: Spa Advanced Treatment Consent Log

Client and Appointment Details

Treatment Requested

Contraindication Screening

Informed Consent and Acknowledgment

Signature and Submission

Get your results