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October Sale! Enjoy Happy Hour Weekdays from 1-3 PM with $40 Spray Tans!
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Oxygeneo Facial
Please fill out the following form
in order to participate in our service.
First name
Last name
Date Of Appointment
Have you had a facial before?
Yes
No
Did you have any trouble with previous facials?
*
Yes
No
What are your specific skincare concerns you would like the Oxygeneo to help with?*
Dry skin
Wrinkles
Acne
Skin Texture
Redness
Breakouts
Blackouts
Large Pores
Skin Sensitivity
Oily Skin
Any known allergies?
Fruits
Shellfish
Latex
Dairy
Wheat
Tree nuts
Lidocane
Fragrance
Pollen
Are you on Accutane?
Yes (Please note treatment can't be done)
No
Are you on birth control?
Yes
No
I hereby agree to have this treatment. I am aware that even with natural ingredients there is a rare chance of a reaction (skin redness, swelling) and there is a possibility of an adverse reaction to product used in facials. I am also aware that certain services should not be performed with certain medical conditions or prescriptions. I have disclosed to the staff at Glitz Spray Tanning all my known medical conditions, skin conditions, allergies, medications and answered all questions honestly on the above form. It is my responsibiliy to disclose all medical, and skin history, as Glitz Spray Tanning will not be responsible to reactions caused by undisclosed medical history. I understand everyones result vary. By signing below, I confirm that I have read and understand the above information and agree to undergo the treatment.
Initials
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