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648 Menlo Ave Suite 4 - Menlo Park, CA
(650) 201-6148
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Airbrush Tanning
Consent Form
Please fill out the form below and we will be in touch with you as soon as we review it:
Contact
Firtst Name
*
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*
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*
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Date of Birth *
Select your date of birth
*
I understand that the purpose of this treatment is aesthetic improvement, not medical diagnosis or cure. I understand that results vary from person to person and therefore cannot be garanteed I understand that some temporary redness, swelling, or mild discomfort may occur after treatment. I have disclosed all relevant medical conditions and medications. I understand that failure to disclose information may result in adverse reactions. I consent to receive treatments performed by Sensè Aesthetic and its licensed professionals I release Sensè Aesthetic and the esthetician from liability related to this procedure, provided it was performed with reasonable care. I acknowledge that my data will be stored securely and only used for professional purposes.
I understand that DHA is clear and can take up to 24 hours fully develop. After spraying, I should not bathe for 24 hours. Exposure to excessive moisture before this time period may affect my results. When my session is over the solution will give me an immediate bronzing effect. When I shower, the bronzer will come off and reveal my true tan color.
I understand that DHA is clear and can take up to 24 hours fully develop. During this time it is important to refrain from moisture build-up on the skin. (i.e. swimming, rain, showering, swearing, massage & pedicures)
I understand not to use these products such as moisturizers, shaving gels or waxes, which contain petrolatum, petroleum jelly, mineral oil or paraben less than 24 hours PRIOR to tanning session as the oils contained in these products may cause a barrier on the skin and will neutralize the DHA bronzing reaction.
I understand that a spray tan only last as long as it takes to my skin to naturally exfoliate 7 to 10 days, depending on skin type and after care.
Are you pregnant or lactating?
*
Please select...
Yes
No
Are you diabetic or had or have any history of skin cancer, glaucoma, cataracts, retinal detachment or retinopathy, Lupus or any skin inflammation or respiratory problems?Are you pregnant or lactating?
*
Please select...
Yes
No
I understand that if in case I am pregnant/lactating, diabetic or had or have any history of skin cancer, glaucoma, cataracts, retinal detachment or retinopathy, Lupus or any skin inflammation or respiratory problems, I MUST HAVE PERMISSION IN WRITING BY A DOCTOR prior to any spray tan session.
I understand that I MUST let Bronze Me Brazilian know in case I'm having any advance allergies, especially of using Accutane as I understand that acne products dry the skin and DHA is very sensitive to dryness.
Are you under 16 years old?
*
Please select...
Yes
No
I understand that if I am planning a laser treatment in the following weeks, I need to consult with my laser technician before having a spray tan.
I understand that freckles may darken with the spray tan service.
I understand that I MUST inform Bronze Me Brazilian if I had sunburn in the last three weeks; otherwise, If I am tanning, I will have some peeling.
I understand that if I have vitiligo, we can’t match the color.
I understand that if I have psoriasis or eczema, I MUST wait for it to clear up; otherwise, the spray tan looks uneven.
By checking all the boxes above, I agree to have these services and I accept all responsibility for such thereby releasing the BMB and the service provider (Technical Professional) from liability.
*
I agree.
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