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Luna Beauty and Wellness
Spray Tanning Intake & Consent Form

Please feel free to ask questions and express any concerns that you may have.

Luna Beauty and Wellness is committed to making you feel comfortable and providing you the best experience possible. Your spray tan technician will choose a solution that is both ideal for your current skin tone and will achieve your desired shade.

 

Your skin should be free of lotion, deodorant, makeup, and anything else that could potentially cause a reaction with the spray tan solution or create barrier on the skin.

The spray tan application will be done in a private area. You may undress to your comfort level. Women may go nude, at their own discretion. The FDA recommends wearing undergarments. If you wish to wear underwear/a bikini, please note that it should be dark in color, to minimize the risk of staining. Please wear loose, dark clothing home from your appointment. Even though the initial bronzers are water soluble and will wash out of most fabrics, no guarantees can be made.

After your tan it is recommended not to shower, sweat or get wet for at least 8-12 hours unless you are doing a ‘rapid’ tan and are advised otherwise. Your first shower should only be a warm water rinse with no soap. The cosmetic bronzer will rinse off during your 1st shower, revealing your tan underneath.  Do not be alarmed if you look lighter after your rinse, it takes up to 24 hours for your tan to fully develop. Pat dry after showering and moisturize at least 2x per day to maximize the life of your tan.

*When choosing a Rapid Tan:

You are responsible for and are in total control of the outcome regarding how light or dark your tan becomes. You will be given specific instructions by your spray tan technician as to how long you must wait before you rinse depending on your natural skin tone and your desired color. If you rinse prematurely you risk underdevelopment and being too light. If you wait too long to rinse you risk being a darker shade than desired.

• 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 if you follow their guide lines to protect mucous membranes. The FDA recommends that you use nose filters, eye covers, lip protection, and protective undergarments. These items are available upon request at no additional charge except for undergarments. The solutions are not considered harmful in the minimal amounts that may be inhaled in a normal spray tanning session.

• 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 ask for the ingredients list if you have any known allergies. If any unfavorable skin reactions occur shower, discontinue use and contact your physician.

• 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. Nursing women may not go topless even when cleared by a doctor for spray tanning.

• Warning – This product does not contain a sunscreen and does not protect against sunburn. It is recommended to use an oil free sunscreen if you are anticipating sun exposure.

Cancellation Policy: I agree and accept the 24 hour cancellation policy which states that a minimum of 24 hours’ notice must be given to cancel and/or reschedule an appointment. If I fail to do so I agree that I will pay Luna Beauty & Wellness the full amount for the service. If I have a gift certificate, voucher or membership credit intended for this service I agree to forfeit its value and pay the difference should there be a remaining balance.

Luna Beauty and Wellness reserves the right to refuse service. Any lewd/disrespectful/sexual/inappropriate comments or behavior will terminate the session and I will be liable for payment of the scheduled treatment. 

Luna Beauty and Wellness has consulted and informed me of what I should expect during this session and what I should do regarding aftercare. I have read this waiver, understand completely and consent to this service. I have been advised that the outcome and longevity of a spray tan depends upon how my skin was prepped, my skin’s age, texture and absorbency ability and the aftercare that is given. To my knowledge, I have no medical condition or allergy which would disqualify 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.

Today's date: September 28, 2021

First Client's Name

First Name*

Last Name*

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

What are your preferred pronouns? *

Referred by *
Have you ever received a spray tan before?*
No
Yes
Do you have any known allergies?*
No
Yes

If yes, please list:
Any related to sunless tanning/ cosmetic products containing Dihydroxyacetone (DHA)?*
No
Yes
Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
What is your desired color:*
Something very subtle, mostly looking for an even skin tone
Just a couple shades darker than I am now
I want to be noticeably tan, but not super dark
As dark as possible while still looking natural
Are you getting a tan for a special occasion or event?*
No
Yes
First Client's Signature*
Second Client's Name

First Name*

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

What are your preferred pronouns? *

Referred by *
Have you ever received a spray tan before?*
No
Yes
Do you have any known allergies?*
No
Yes

If yes, please list:
Any related to sunless tanning/ cosmetic products containing Dihydroxyacetone (DHA)?*
No
Yes
Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
What is your desired color:*
Something very subtle, mostly looking for an even skin tone
Just a couple shades darker than I am now
I want to be noticeably tan, but not super dark
As dark as possible while still looking natural
Are you getting a tan for a special occasion or event?*
No
Yes
Third Client's Name

First Name*

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

What are your preferred pronouns? *

Referred by *
Have you ever received a spray tan before?*
No
Yes
Do you have any known allergies?*
No
Yes

If yes, please list:
Any related to sunless tanning/ cosmetic products containing Dihydroxyacetone (DHA)?*
No
Yes
Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
What is your desired color:*
Something very subtle, mostly looking for an even skin tone
Just a couple shades darker than I am now
I want to be noticeably tan, but not super dark
As dark as possible while still looking natural
Are you getting a tan for a special occasion or event?*
No
Yes
Fourth Client's Name

First Name*

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

What are your preferred pronouns? *

Referred by *
Have you ever received a spray tan before?*
No
Yes
Do you have any known allergies?*
No
Yes

If yes, please list:
Any related to sunless tanning/ cosmetic products containing Dihydroxyacetone (DHA)?*
No
Yes
Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
What is your desired color:*
Something very subtle, mostly looking for an even skin tone
Just a couple shades darker than I am now
I want to be noticeably tan, but not super dark
As dark as possible while still looking natural
Are you getting a tan for a special occasion or event?*
No
Yes
Fifth Client's Name

First Name*

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

What are your preferred pronouns? *

Referred by *
Have you ever received a spray tan before?*
No
Yes
Do you have any known allergies?*
No
Yes

If yes, please list:
Any related to sunless tanning/ cosmetic products containing Dihydroxyacetone (DHA)?*
No
Yes
Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
What is your desired color:*
Something very subtle, mostly looking for an even skin tone
Just a couple shades darker than I am now
I want to be noticeably tan, but not super dark
As dark as possible while still looking natural
Are you getting a tan for a special occasion or event?*
No
Yes
Sixth Client's Name

First Name*

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

What are your preferred pronouns? *

Referred by *
Have you ever received a spray tan before?*
No
Yes
Do you have any known allergies?*
No
Yes

If yes, please list:
Any related to sunless tanning/ cosmetic products containing Dihydroxyacetone (DHA)?*
No
Yes
Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
What is your desired color:*
Something very subtle, mostly looking for an even skin tone
Just a couple shades darker than I am now
I want to be noticeably tan, but not super dark
As dark as possible while still looking natural
Are you getting a tan for a special occasion or event?*
No
Yes
Seventh Client's Name

First Name*

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

What are your preferred pronouns? *

Referred by *
Have you ever received a spray tan before?*
No
Yes
Do you have any known allergies?*
No
Yes

If yes, please list:
Any related to sunless tanning/ cosmetic products containing Dihydroxyacetone (DHA)?*
No
Yes
Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
What is your desired color:*
Something very subtle, mostly looking for an even skin tone
Just a couple shades darker than I am now
I want to be noticeably tan, but not super dark
As dark as possible while still looking natural
Are you getting a tan for a special occasion or event?*
No
Yes
Eighth Client's Name

First Name*

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

What are your preferred pronouns? *

Referred by *
Have you ever received a spray tan before?*
No
Yes
Do you have any known allergies?*
No
Yes

If yes, please list:
Any related to sunless tanning/ cosmetic products containing Dihydroxyacetone (DHA)?*
No
Yes
Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
What is your desired color:*
Something very subtle, mostly looking for an even skin tone
Just a couple shades darker than I am now
I want to be noticeably tan, but not super dark
As dark as possible while still looking natural
Are you getting a tan for a special occasion or event?*
No
Yes
Ninth Client's Name

First Name*

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

What are your preferred pronouns? *

Referred by *
Have you ever received a spray tan before?*
No
Yes
Do you have any known allergies?*
No
Yes

If yes, please list:
Any related to sunless tanning/ cosmetic products containing Dihydroxyacetone (DHA)?*
No
Yes
Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
What is your desired color:*
Something very subtle, mostly looking for an even skin tone
Just a couple shades darker than I am now
I want to be noticeably tan, but not super dark
As dark as possible while still looking natural
Are you getting a tan for a special occasion or event?*
No
Yes
Tenth Client's Name

First Name*

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

What are your preferred pronouns? *

Referred by *
Have you ever received a spray tan before?*
No
Yes
Do you have any known allergies?*
No
Yes

If yes, please list:
Any related to sunless tanning/ cosmetic products containing Dihydroxyacetone (DHA)?*
No
Yes
Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
What is your desired color:*
Something very subtle, mostly looking for an even skin tone
Just a couple shades darker than I am now
I want to be noticeably tan, but not super dark
As dark as possible while still looking natural
Are you getting a tan for a special occasion or event?*
No
Yes
Client's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
I confirm that I have read and understand all information on the applicable forms for this treatment or service and accept responsibility on my child’s behalf for any disclosures or liability described on those forms. I agree and give permission for my child to have the above services performed today and going forward as needed. I agree to supervise any home care procedures that are recommended as a result of the treatment. Clients under the age of 18 must wear a swimsuit/underwear and be accompanied by a parent or legal guardian during the entire session. Informed written consent must be provided by parent or legal guardian for any client under the age of 18.
Parent or Guardian's Name

First Name*

Last Name*

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

What are your preferred pronouns? *

Referred by *
Have you ever received a spray tan before?*
No
Yes
Do you have any known allergies?*
No
Yes

If yes, please list:
Any related to sunless tanning/ cosmetic products containing Dihydroxyacetone (DHA)?*
No
Yes
Do you have any skin conditions?*
No
Yes

If yes, please list:
Do you have any respiratory illnesses?*
No
Yes
What is your desired color:*
Something very subtle, mostly looking for an even skin tone
Just a couple shades darker than I am now
I want to be noticeably tan, but not super dark
As dark as possible while still looking natural
Are you getting a tan for a special occasion or event?*
No
Yes
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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