Run Spa Advanced Treatment Consent Log — Free

Client and Visit Details

Client name (required)

Service date (required)

Provider name (required)

Treatment type (required)

If other, describe the treatment

Consent and Disclosure

The treatment, expected benefits, and common risks were explained to me in language I understand. (required)

Yes No N/A

I received aftercare instructions and understand that following them is important for safe healing. (required)

Yes No N/A

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

Yes No N/A

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

Yes No N/A

Client signature (required)

Contraindication Screening

Are you pregnant or nursing? (required)

Have you used isotretinoin (Accutane) in the past 6 months? (required)

Have you had a peel, laser, waxing, or other exfoliating treatment in the last 14 days? (required)

Do you currently have any of the following in the treatment area?

If you selected any condition other than 'None of the above', describe the area and concern

Medical and Sensitivity History

Do you have any allergies or sensitivities relevant to skincare products or acids? (required)

If yes or unsure, describe the allergy or sensitivity

Have there been any recent medication changes that may affect skin sensitivity? (required)

If yes or unsure, describe the medication change

Provider Review and Outcome

Screening result (required)

Provider notes or rationale

Get your results

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Email (required)

Your name (optional)

Run: Spa Advanced Treatment Consent Log

Client and Visit Details

Consent and Disclosure

Contraindication Screening

Medical and Sensitivity History

Provider Review and Outcome

Get your results