Consent Form – KSkin Studio

Thank you for choosing KSkin Studio! Please complete this form before your appointment. Your responses help us provide the safest and most effective care for your skin.

Personal Information

First Name *

Last Name

Phone Number *

Email Address *

Date of Birth *

Emergency Contact (Name & Phone)

Medical Information

Please check any conditions that apply:DiabetesEpilepsyHeart Condition / High Blood PressurePregnancy or NursingSkin Allergies or SensitivitiesRecent Botox or Fillers (within 2 weeks)Use of Retin-A / Accutane / AHA / BHA productsRecent Chemical Peel / Laser / MicroneedlingOther

If Other, please describe:

Are you currently under a dermatologist’s care?NoYes

If yes, please explain:

Have you had any recent facial surgeries or procedures?NoYes

If yes, please specify:

Are you currently taking any medications (topical or oral)?NoYes

If yes, please list:

Skin Information

How would you describe your skin type?NormalOilyDryCombinationSensitive

What are your primary skin concerns?Acne / BreakoutsDryness / DehydrationHyperpigmentation / Uneven ToneAging / Fine LinesRedness / SensitivityOther

If Other, please specify:

Do you have any allergies (including skincare ingredients or latex)?NoYes

If yes, please list:

What skincare products do you currently use?

Teen Facial – Minimum Age Policy

Please note that our Teen Facial services are available only to clients who are at least 14 years old (the “Minimum Age”).

We do not knowingly collect, process, disclose, or share personal information from anyone under the Minimum Age without the consent of a parent or legal guardian.

If you are under the Minimum Age, you are not permitted to:

Use or provide any information on our website
Register for an account
Make any purchases through our website
Share any personal details, including:

First Name

Last Name

Home or billing address

Thank you for helping maintain a safe and appropriate environment for all clients.

Treatment Consent

I understand that the skincare treatments and services provided by KSkin Studio are intended to improve the appearance and health of my skin, but individual results may vary. I acknowledge that:

I have disclosed all relevant health and skin information.
I will inform my esthetician of any discomfort during treatment.
Certain products or procedures may cause mild redness or irritation.
My esthetician may recommend home care products for optimal results.

I hereby release KSkin Studio and its esthetician(s) from any liability associated with adverse reactions that may occur as a result of my disclosed (or undisclosed) conditions.

Consent *

I agree to the terms and consent to receive skincare services from KSkin Studio.

Signature (type full name) *

Date *