Skin and Body Treatment 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 *

Email *

Phone Number *

Adress

Adress Line 1

Adress Line 2

City

Estate

Date of Birth *

Select your date of birth *

What is your primary reason for seeking treatment?

Are you currently under medical care? *

Please describe medical care: *

Are you currently taking any medications, including antibiotics or Accutane? *

Please describe medication(s): *

Have you had any cosmetic or aesthetic treatments in the past 6 months? *

Please describe treatment(s): *

Do you have any known allergies (especially to skincare ingredients)? *

Please describe allergy(s): *

Do you have any skin conditions (rosacea, eczema, acne, psoriasis)? *

Please list skin condition(s): *

Do you have a pacemaker, metal implants, or recent surgery? *

Please describe: *

Are you pregnant or breastfeeding? *

Do you have a history of cancer or autoimmune conditions? *

Please describe condition(s):

Consent *

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.

Photo / Image Authorization: *

Internal progress tracking (for my treatment record)

Marketing purposes (We always respect privacy — no personal details will ever be shared)