Tan


Lavender-Falls-Stone-Oak-Spa-San-Antonio

Lavender Falls Face & Body Spa LLC

Client Informed Consent Form

Spray Tan

 

PLEASE READ CAREFULLY & COMPLETELY

 

 

19239 Stone Oak Pkwy, Suite #201

San Antonio, Texas 78258

Phone: 210-446-0903

www.sanantonio.lavenderskinspa.com

Online Booking Available

Treatment Consists of:

      Spray tanning is accomplished by application of a solution containing the active ingredient: DHA (Dihydroxyacetone). DHA is considered to be safe and has been FDA approved ONLY if you follow the guidelines to protect mucous membranes.

      You will enter a private room where you will remove your clothing. This is up to you and your level of comfort. You should wear a dark swimsuit or underwear. Spa undergarments may be available upon request. The solution will wash out of most clothing. It is always best to wear dark loose fitting cotton clothing. It is advised to wash the undergarment or clothing worn as soon as possible after your session.

      You will be sprayed. This process will take approximately ten to fifteen minutes

      After spraying, your skin should be dry before putting your clothes back on and you should not bathe or sweat excessively for nine hours. The solution will give you an immediate bronzing effect.

Clients Who Should NOT Be Treated:

Be advised there is a small percentage of people whose skin may not react favorably to spray tanning. For this reason, we do NOT advise being sprayed for the first time when your appearance is critical; (wedding/special occasion)

• Caution – Pregnant or nursing women should consult their physician before using.

• Warning – This product does not contain a sunscreen and does not protect against sunburn.

Medical Information: I acknowledge I am not currently nor have used any of the products listed below within the time frame listed.

Pre-Treatment Acknowledgement

The FDA advises asking the following questions when

considering the application of DHA by spraying or misting:

      Are you protected from exposure in the entire area of the eyes, in addition to the eyes themselves?

      Are you protected from exposure on the lips and all parts of the body covered by mucous membrane?

      Are you protected from internal exposure caused by inhaling or ingesting the product?

If the answer to any of these questions is “no,” you are not protected from the unapproved use of DHA. You should request measures to protect your eyes and mucous membranes and prevent inhalation

      Allergies – I am not allergic to any of the ingredients in the prescribed treatment.

Post Treatment Acknowledgement

      Warning – This product does not contain a sunscreen and does not protect against sunburn. Repeated exposure of unprotected skin to U.V. Light may increase the risk of skin aging, skin cancer and other harmful effects to the skin even if you do not burn.

      Clothing- It is advised to wash the undergarment or clothing worn as soon as possible after your session.

      You should not bathe or sweat excessively for nine hours. The solution will give you an immediate bronzing effect. This is a result of a coloring additive in the solution that will remain on the skin until you are actually tan.

      When you shower, the coloring will come off to reveal your actual tan beneath.

Side Effects:

Possible side effects include but are not limited to:

• All people are different. All ingredients used in this procedure are intended for cosmetic use and generally regarded as safe. There are, however, occasions where individuals may be allergic to one or more ingredients in the spray tan solution. Please read the ingredients list if you have any known allergies.

Acknowledgements:

      The Spray Tanning treatment has been fully explained and any questions or concerns that I have, have been addressed.

      I have been provided with spray tan care instructions, which I have read and understand completely.

      To my knowledge, I have no medical condition or allergy which would preclude me from having this procedure done.

      I have been honest and accurate about the information that I have provided on this waiver.

      I take sole responsibility of any reaction I may have, staining of clothing and/or personal belongings.

      I acknowledge that no guarantee has been given to me due to each individual’s unique reactions.

      I acknowledge this procedure is strictly an elective cosmetic procedure and that no medical claims have been expressed or implied.

      Photographs May be taken for comparison for future treatments for my chart.

 

I have read the above and understand it. My provider has answered my questions satisfactorily. I accept the possible risks and complications of the treatment.

 

I acknowledge that Lavender Falls Face and Body Spa has a no-refund policy on any products or service. There will be no refunds for any reason.

 

All services performed are without any guarantee. By continuing with service, you are confirming that you have read and understand our no refunds policy.

 

 

 

Lavender Falls Face and Body Spa LLC

Thank you for choosing and trusting Lavender Falls Face & Body Spa LLC for your aesthetic needs.

Feel free to contact us at 210-446-0903 if you have any questions

           

 

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Lavender Falls Face & Body Spa | Facials, Eyelash Extensions, Massage, Permanent Makeup, Eyebrow Microblading https://sanantonio.lavenderskinspa.com
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Document name: Tan
Unique Document ID: 0d293ac2fe33b83d5f59541ef7bbee0558cf1160
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April 8, 2017 8:37 pm CSTTan Uploaded by Lavender Falls Face and Body Spa LLC. - lavenderfallstx@gmail.com IP 162.198.97.65