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Completing the form below will assist us with performing your aesthetic service.

All information is collected by Ivonne Sanchez Beauty pursuant to O. Reg. 136/18: PERSONAL SERVICE SETTINGS and The Personal Information Protection and Electronic Documents Act (“PIPEDA “).

First Client's Name

First Name*

Last Name*

Phone*
First Client's Date of Birth*
First Client's Information

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Do you have concerns about any of the following?
Dryness
Sensitivity
Broken Capillaries
Fine Lines/Wrinkles
Pigmentation/Age Spots
Puffy Eyes
Dehydration
Oily skin
Rosacea
Sun Damage
Dark Circles Under Eyes
Acne
Breakouts
Decreased Elastin
Scarring
Other: Please specify below
Have you ever been or are you currently under the care of a Dermatologist?*
No
Yes

If yes, for what reasons?

Click to customize multiple choice*
Option 1
Option 2
Option 3
Please indicate whether you are using any of the following:
Birth Control
Tetracycline
Vitamin A
Retinol
A.H.A (Alpha Hydroxy Acid)
Acne Medication
Are you Claustrophobic or uncomfortable in small, dark or uncertain places?*
No
Yes
Do you have high blood pressure?*
No
Yes
Are you wearing contact lenses?*
No
Yes
Are you pregnant or breast feeding?*
No
Yes
Do you wear sunblock or suncare?*
No
Yes
Do you have any allergies?*
No
Yes

If yes, please provide details.

Do you have a pacemaker or metal pins or plates anywhere in your body?*
No
Yes

If yes, please provide details:

Have you had any recent cosmetic surgery? (last 6 months)*
No
Yes

If yes, for what area and when?

Are there any specific concerns or additional information that we should know about in order to customize your treatment?

I am over the age of 18 and I am aware that accurate health history is necessary to ensure that my services are delivered safely and in the context of what my body needs. I have answered all of the above questions accurately and to the best of my ability. I have and will ask any questions to my complete satisfaction before proceeding with any treatment. I agree to notify my aesthetician of any health changes in order to qualify and proceed with any future services.

First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Second Client's Information

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Do you have concerns about any of the following?
Dryness
Sensitivity
Broken Capillaries
Fine Lines/Wrinkles
Pigmentation/Age Spots
Puffy Eyes
Dehydration
Oily skin
Rosacea
Sun Damage
Dark Circles Under Eyes
Acne
Breakouts
Decreased Elastin
Scarring
Other: Please specify below
Have you ever been or are you currently under the care of a Dermatologist?*
No
Yes

If yes, for what reasons?

Click to customize multiple choice*
Option 1
Option 2
Option 3
Please indicate whether you are using any of the following:
Birth Control
Tetracycline
Vitamin A
Retinol
A.H.A (Alpha Hydroxy Acid)
Acne Medication
Are you Claustrophobic or uncomfortable in small, dark or uncertain places?*
No
Yes
Do you have high blood pressure?*
No
Yes
Are you wearing contact lenses?*
No
Yes
Are you pregnant or breast feeding?*
No
Yes
Do you wear sunblock or suncare?*
No
Yes
Do you have any allergies?*
No
Yes

If yes, please provide details.

Do you have a pacemaker or metal pins or plates anywhere in your body?*
No
Yes

If yes, please provide details:

Have you had any recent cosmetic surgery? (last 6 months)*
No
Yes

If yes, for what area and when?

Are there any specific concerns or additional information that we should know about in order to customize your treatment?

I am over the age of 18 and I am aware that accurate health history is necessary to ensure that my services are delivered safely and in the context of what my body needs. I have answered all of the above questions accurately and to the best of my ability. I have and will ask any questions to my complete satisfaction before proceeding with any treatment. I agree to notify my aesthetician of any health changes in order to qualify and proceed with any future services.

Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Third Client's Information

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Do you have concerns about any of the following?
Dryness
Sensitivity
Broken Capillaries
Fine Lines/Wrinkles
Pigmentation/Age Spots
Puffy Eyes
Dehydration
Oily skin
Rosacea
Sun Damage
Dark Circles Under Eyes
Acne
Breakouts
Decreased Elastin
Scarring
Other: Please specify below
Have you ever been or are you currently under the care of a Dermatologist?*
No
Yes

If yes, for what reasons?

Click to customize multiple choice*
Option 1
Option 2
Option 3
Please indicate whether you are using any of the following:
Birth Control
Tetracycline
Vitamin A
Retinol
A.H.A (Alpha Hydroxy Acid)
Acne Medication
Are you Claustrophobic or uncomfortable in small, dark or uncertain places?*
No
Yes
Do you have high blood pressure?*
No
Yes
Are you wearing contact lenses?*
No
Yes
Are you pregnant or breast feeding?*
No
Yes
Do you wear sunblock or suncare?*
No
Yes
Do you have any allergies?*
No
Yes

If yes, please provide details.

Do you have a pacemaker or metal pins or plates anywhere in your body?*
No
Yes

If yes, please provide details:

Have you had any recent cosmetic surgery? (last 6 months)*
No
Yes

If yes, for what area and when?

Are there any specific concerns or additional information that we should know about in order to customize your treatment?

I am over the age of 18 and I am aware that accurate health history is necessary to ensure that my services are delivered safely and in the context of what my body needs. I have answered all of the above questions accurately and to the best of my ability. I have and will ask any questions to my complete satisfaction before proceeding with any treatment. I agree to notify my aesthetician of any health changes in order to qualify and proceed with any future services.

Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fourth Client's Information

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Do you have concerns about any of the following?
Dryness
Sensitivity
Broken Capillaries
Fine Lines/Wrinkles
Pigmentation/Age Spots
Puffy Eyes
Dehydration
Oily skin
Rosacea
Sun Damage
Dark Circles Under Eyes
Acne
Breakouts
Decreased Elastin
Scarring
Other: Please specify below
Have you ever been or are you currently under the care of a Dermatologist?*
No
Yes

If yes, for what reasons?

Click to customize multiple choice*
Option 1
Option 2
Option 3
Please indicate whether you are using any of the following:
Birth Control
Tetracycline
Vitamin A
Retinol
A.H.A (Alpha Hydroxy Acid)
Acne Medication
Are you Claustrophobic or uncomfortable in small, dark or uncertain places?*
No
Yes
Do you have high blood pressure?*
No
Yes
Are you wearing contact lenses?*
No
Yes
Are you pregnant or breast feeding?*
No
Yes
Do you wear sunblock or suncare?*
No
Yes
Do you have any allergies?*
No
Yes

If yes, please provide details.

Do you have a pacemaker or metal pins or plates anywhere in your body?*
No
Yes

If yes, please provide details:

Have you had any recent cosmetic surgery? (last 6 months)*
No
Yes

If yes, for what area and when?

Are there any specific concerns or additional information that we should know about in order to customize your treatment?

I am over the age of 18 and I am aware that accurate health history is necessary to ensure that my services are delivered safely and in the context of what my body needs. I have answered all of the above questions accurately and to the best of my ability. I have and will ask any questions to my complete satisfaction before proceeding with any treatment. I agree to notify my aesthetician of any health changes in order to qualify and proceed with any future services.

Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Fifth Client's Information

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Do you have concerns about any of the following?
Dryness
Sensitivity
Broken Capillaries
Fine Lines/Wrinkles
Pigmentation/Age Spots
Puffy Eyes
Dehydration
Oily skin
Rosacea
Sun Damage
Dark Circles Under Eyes
Acne
Breakouts
Decreased Elastin
Scarring
Other: Please specify below
Have you ever been or are you currently under the care of a Dermatologist?*
No
Yes

If yes, for what reasons?

Click to customize multiple choice*
Option 1
Option 2
Option 3
Please indicate whether you are using any of the following:
Birth Control
Tetracycline
Vitamin A
Retinol
A.H.A (Alpha Hydroxy Acid)
Acne Medication
Are you Claustrophobic or uncomfortable in small, dark or uncertain places?*
No
Yes
Do you have high blood pressure?*
No
Yes
Are you wearing contact lenses?*
No
Yes
Are you pregnant or breast feeding?*
No
Yes
Do you wear sunblock or suncare?*
No
Yes
Do you have any allergies?*
No
Yes

If yes, please provide details.

Do you have a pacemaker or metal pins or plates anywhere in your body?*
No
Yes

If yes, please provide details:

Have you had any recent cosmetic surgery? (last 6 months)*
No
Yes

If yes, for what area and when?

Are there any specific concerns or additional information that we should know about in order to customize your treatment?

I am over the age of 18 and I am aware that accurate health history is necessary to ensure that my services are delivered safely and in the context of what my body needs. I have answered all of the above questions accurately and to the best of my ability. I have and will ask any questions to my complete satisfaction before proceeding with any treatment. I agree to notify my aesthetician of any health changes in order to qualify and proceed with any future services.

Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Sixth Client's Information

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Do you have concerns about any of the following?
Dryness
Sensitivity
Broken Capillaries
Fine Lines/Wrinkles
Pigmentation/Age Spots
Puffy Eyes
Dehydration
Oily skin
Rosacea
Sun Damage
Dark Circles Under Eyes
Acne
Breakouts
Decreased Elastin
Scarring
Other: Please specify below
Have you ever been or are you currently under the care of a Dermatologist?*
No
Yes

If yes, for what reasons?

Click to customize multiple choice*
Option 1
Option 2
Option 3
Please indicate whether you are using any of the following:
Birth Control
Tetracycline
Vitamin A
Retinol
A.H.A (Alpha Hydroxy Acid)
Acne Medication
Are you Claustrophobic or uncomfortable in small, dark or uncertain places?*
No
Yes
Do you have high blood pressure?*
No
Yes
Are you wearing contact lenses?*
No
Yes
Are you pregnant or breast feeding?*
No
Yes
Do you wear sunblock or suncare?*
No
Yes
Do you have any allergies?*
No
Yes

If yes, please provide details.

Do you have a pacemaker or metal pins or plates anywhere in your body?*
No
Yes

If yes, please provide details:

Have you had any recent cosmetic surgery? (last 6 months)*
No
Yes

If yes, for what area and when?

Are there any specific concerns or additional information that we should know about in order to customize your treatment?

I am over the age of 18 and I am aware that accurate health history is necessary to ensure that my services are delivered safely and in the context of what my body needs. I have answered all of the above questions accurately and to the best of my ability. I have and will ask any questions to my complete satisfaction before proceeding with any treatment. I agree to notify my aesthetician of any health changes in order to qualify and proceed with any future services.

Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Seventh Client's Information

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Do you have concerns about any of the following?
Dryness
Sensitivity
Broken Capillaries
Fine Lines/Wrinkles
Pigmentation/Age Spots
Puffy Eyes
Dehydration
Oily skin
Rosacea
Sun Damage
Dark Circles Under Eyes
Acne
Breakouts
Decreased Elastin
Scarring
Other: Please specify below
Have you ever been or are you currently under the care of a Dermatologist?*
No
Yes

If yes, for what reasons?

Click to customize multiple choice*
Option 1
Option 2
Option 3
Please indicate whether you are using any of the following:
Birth Control
Tetracycline
Vitamin A
Retinol
A.H.A (Alpha Hydroxy Acid)
Acne Medication
Are you Claustrophobic or uncomfortable in small, dark or uncertain places?*
No
Yes
Do you have high blood pressure?*
No
Yes
Are you wearing contact lenses?*
No
Yes
Are you pregnant or breast feeding?*
No
Yes
Do you wear sunblock or suncare?*
No
Yes
Do you have any allergies?*
No
Yes

If yes, please provide details.

Do you have a pacemaker or metal pins or plates anywhere in your body?*
No
Yes

If yes, please provide details:

Have you had any recent cosmetic surgery? (last 6 months)*
No
Yes

If yes, for what area and when?

Are there any specific concerns or additional information that we should know about in order to customize your treatment?

I am over the age of 18 and I am aware that accurate health history is necessary to ensure that my services are delivered safely and in the context of what my body needs. I have answered all of the above questions accurately and to the best of my ability. I have and will ask any questions to my complete satisfaction before proceeding with any treatment. I agree to notify my aesthetician of any health changes in order to qualify and proceed with any future services.

Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Eighth Client's Information

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Do you have concerns about any of the following?
Dryness
Sensitivity
Broken Capillaries
Fine Lines/Wrinkles
Pigmentation/Age Spots
Puffy Eyes
Dehydration
Oily skin
Rosacea
Sun Damage
Dark Circles Under Eyes
Acne
Breakouts
Decreased Elastin
Scarring
Other: Please specify below
Have you ever been or are you currently under the care of a Dermatologist?*
No
Yes

If yes, for what reasons?

Click to customize multiple choice*
Option 1
Option 2
Option 3
Please indicate whether you are using any of the following:
Birth Control
Tetracycline
Vitamin A
Retinol
A.H.A (Alpha Hydroxy Acid)
Acne Medication
Are you Claustrophobic or uncomfortable in small, dark or uncertain places?*
No
Yes
Do you have high blood pressure?*
No
Yes
Are you wearing contact lenses?*
No
Yes
Are you pregnant or breast feeding?*
No
Yes
Do you wear sunblock or suncare?*
No
Yes
Do you have any allergies?*
No
Yes

If yes, please provide details.

Do you have a pacemaker or metal pins or plates anywhere in your body?*
No
Yes

If yes, please provide details:

Have you had any recent cosmetic surgery? (last 6 months)*
No
Yes

If yes, for what area and when?

Are there any specific concerns or additional information that we should know about in order to customize your treatment?

I am over the age of 18 and I am aware that accurate health history is necessary to ensure that my services are delivered safely and in the context of what my body needs. I have answered all of the above questions accurately and to the best of my ability. I have and will ask any questions to my complete satisfaction before proceeding with any treatment. I agree to notify my aesthetician of any health changes in order to qualify and proceed with any future services.

Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Ninth Client's Information

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Do you have concerns about any of the following?
Dryness
Sensitivity
Broken Capillaries
Fine Lines/Wrinkles
Pigmentation/Age Spots
Puffy Eyes
Dehydration
Oily skin
Rosacea
Sun Damage
Dark Circles Under Eyes
Acne
Breakouts
Decreased Elastin
Scarring
Other: Please specify below
Have you ever been or are you currently under the care of a Dermatologist?*
No
Yes

If yes, for what reasons?

Click to customize multiple choice*
Option 1
Option 2
Option 3
Please indicate whether you are using any of the following:
Birth Control
Tetracycline
Vitamin A
Retinol
A.H.A (Alpha Hydroxy Acid)
Acne Medication
Are you Claustrophobic or uncomfortable in small, dark or uncertain places?*
No
Yes
Do you have high blood pressure?*
No
Yes
Are you wearing contact lenses?*
No
Yes
Are you pregnant or breast feeding?*
No
Yes
Do you wear sunblock or suncare?*
No
Yes
Do you have any allergies?*
No
Yes

If yes, please provide details.

Do you have a pacemaker or metal pins or plates anywhere in your body?*
No
Yes

If yes, please provide details:

Have you had any recent cosmetic surgery? (last 6 months)*
No
Yes

If yes, for what area and when?

Are there any specific concerns or additional information that we should know about in order to customize your treatment?

I am over the age of 18 and I am aware that accurate health history is necessary to ensure that my services are delivered safely and in the context of what my body needs. I have answered all of the above questions accurately and to the best of my ability. I have and will ask any questions to my complete satisfaction before proceeding with any treatment. I agree to notify my aesthetician of any health changes in order to qualify and proceed with any future services.

Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Tenth Client's Information

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Do you have concerns about any of the following?
Dryness
Sensitivity
Broken Capillaries
Fine Lines/Wrinkles
Pigmentation/Age Spots
Puffy Eyes
Dehydration
Oily skin
Rosacea
Sun Damage
Dark Circles Under Eyes
Acne
Breakouts
Decreased Elastin
Scarring
Other: Please specify below
Have you ever been or are you currently under the care of a Dermatologist?*
No
Yes

If yes, for what reasons?

Click to customize multiple choice*
Option 1
Option 2
Option 3
Please indicate whether you are using any of the following:
Birth Control
Tetracycline
Vitamin A
Retinol
A.H.A (Alpha Hydroxy Acid)
Acne Medication
Are you Claustrophobic or uncomfortable in small, dark or uncertain places?*
No
Yes
Do you have high blood pressure?*
No
Yes
Are you wearing contact lenses?*
No
Yes
Are you pregnant or breast feeding?*
No
Yes
Do you wear sunblock or suncare?*
No
Yes
Do you have any allergies?*
No
Yes

If yes, please provide details.

Do you have a pacemaker or metal pins or plates anywhere in your body?*
No
Yes

If yes, please provide details:

Have you had any recent cosmetic surgery? (last 6 months)*
No
Yes

If yes, for what area and when?

Are there any specific concerns or additional information that we should know about in order to customize your treatment?

I am over the age of 18 and I am aware that accurate health history is necessary to ensure that my services are delivered safely and in the context of what my body needs. I have answered all of the above questions accurately and to the best of my ability. I have and will ask any questions to my complete satisfaction before proceeding with any treatment. I agree to notify my aesthetician of any health changes in order to qualify and proceed with any future services.

Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Do you have concerns about any of the following?
Dryness
Sensitivity
Broken Capillaries
Fine Lines/Wrinkles
Pigmentation/Age Spots
Puffy Eyes
Dehydration
Oily skin
Rosacea
Sun Damage
Dark Circles Under Eyes
Acne
Breakouts
Decreased Elastin
Scarring
Other: Please specify below
Have you ever been or are you currently under the care of a Dermatologist?*
No
Yes

If yes, for what reasons?

Click to customize multiple choice*
Option 1
Option 2
Option 3
Please indicate whether you are using any of the following:
Birth Control
Tetracycline
Vitamin A
Retinol
A.H.A (Alpha Hydroxy Acid)
Acne Medication
Are you Claustrophobic or uncomfortable in small, dark or uncertain places?*
No
Yes
Do you have high blood pressure?*
No
Yes
Are you wearing contact lenses?*
No
Yes
Are you pregnant or breast feeding?*
No
Yes
Do you wear sunblock or suncare?*
No
Yes
Do you have any allergies?*
No
Yes

If yes, please provide details.

Do you have a pacemaker or metal pins or plates anywhere in your body?*
No
Yes

If yes, please provide details:

Have you had any recent cosmetic surgery? (last 6 months)*
No
Yes

If yes, for what area and when?

Are there any specific concerns or additional information that we should know about in order to customize your treatment?

I am over the age of 18 and I am aware that accurate health history is necessary to ensure that my services are delivered safely and in the context of what my body needs. I have answered all of the above questions accurately and to the best of my ability. I have and will ask any questions to my complete satisfaction before proceeding with any treatment. I agree to notify my aesthetician of any health changes in order to qualify and proceed with any future services.

Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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