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Murad Facial Form

Birthday
1. Avoid facial treatment if any of the following apply to you (check if it applies to you):
2. What is your skin type?
3. What Primary Skin Concerns Do You Have? (choose one)
4. What Secondary Skin Concerns Do You Have?
5. Let us know your sensitive skin symptoms:
I have a tendency towards redness
I am sensitive to extreme temperature
I get easily irritated by skincare products
6. Let us know about your allergies, if applicable:
7. How do you currently take care of your skin? Check all that apply.
8. Let us know about your medication: Check all that apply.
9. Let us know about your general health: Check all that apply.

I hereby consent to the use of my personal data (including any sensitive personal data) for the purpose of my treatment and any future treatment. It is my responsibility to inform my Beauty Therapist of any of my pre-existing conditions, limitations or specific sensitivities, and to inform her or him if I feel any discomfort during the session. I understand that if I expose myself to any of the products, services, or items listed on this release form and do not inform my Beauty Therapist, or choose to proceed against my Beauty Therapist's recommendation, I am accepting

full responsibility for any possible reaction. I have read the above information and give my permission to my Beauty Therapist to perform the procedure, and I agree to hold my Beauty Therapist and the spa harmless of any liability that may result from this treatment.

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