Aliya's Beauty Salon
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Consent Forms

Review each treatment consent form here. Logged-in clients can update their saved answers; guests can print any form and log in to submit it online.

Brow Henna Consent Form Brow Lamination Consent Form Brow Wax & Tint Consent Form Dermaplaning Consent Form Lash Extensions Consent Form Lash Lift Consent Form Microneedling Consent Form

Dermaplaning Consent Form

Version 2026.03.17
Register or log in to complete and submit this form online. Guests can still print this page for offline use.

Client Information

Skin Care Goals

Medical Information

Have you ever had a skin analysis?
Any allergies/sensitivities?
If yes, please list
Are you pregnant and/or nursing?
Are you diabetic?
Have you ever had any cold sores, herpes, hives, or keloids?
Do you wear contact lenses?
Do you wear sunscreen on a regular basis?
Have you visited a tanning booth within the last week?
Are you currently taking any antibiotics?
Are you using acne medication (Accutane) or topical creams?
Are you currently under the care of a dermatologist?

Skin Care Information

Are you currently using products containing Glycolic Acid or Alpha Hydroxy Acid (AHA)?
If yes, list the product
Does your skin get red after exfoliation?
Are you currently doing electrolysis/laser treatments to your face?
If so, when was your last treatment?
Are you currently using skincare products at home?
If so, please list the products

Have you had any of the following?

Microdermabrasion facial
If yes, when was your last treatment?
Chemical peel
If yes, when was your last treatment?
Laser resurfacing
If yes, when was your last treatment?
Botox and/or filler
If yes, when was your last treatment?
Facial surgery
If yes, when was your last treatment?

Dermaplaning is a controlled exfoliation treatment. The body responds to this treatment by increasing circulation and cell renewal, while the trained professional carefully removes dead skin cells and vellus hair from the skin's surface. Along with home-care instructions and supportive skincare, the treatment helps promote normal shedding of the stratum corneum, improve skin texture, and reduce the appearance of fine lines, wrinkles, milia, and congested pores.

I understand I am receiving an exfoliation treatment using a sterile surgical blade.

I understand the possible side effects include but are not limited to skin tightness, mild to moderate redness, mild flaking, and possible nicks.

I understand this procedure removes most, not all vellus hair (peach fuzz). I understand the results of this treatment may vary due to conditions such as age, condition of the skin, sun damage, climate, etc.

I understand this treatment is a cosmetic treatment and no medical claims are expressed or implied.

I understand that direct sun exposure, including tanning beds, is not advised while undergoing treatment and the use of sunscreen is recommended.

I understand that any facial injections should be avoided for 10 days before this treatment. I agree to avoid Retinol and/or Retin-A within 5 to 7 days before and after my treatment. I have been advised to avoid scheduling cosmetic surgery close to my treatment. I have been advised not to receive this treatment if I am undergoing Accutane therapy.

I hereby consent to the treatment and agree to have it performed on me. I further agree to follow all post-care instructions provided by my practitioner. I have been candid in revealing any condition that may have a bearing on this procedure. I waive and release any related claim to the fullest extent permitted by law.

Consent & Liability

I affirm that I have stated all my known medical conditions and answered all questions truthfully. I agree to keep this record updated as to any changes in my medical profile for any future treatments with Aliya's Beauty. I understand that there shall be no liability to Aliya's Beauty should I fail to do so.

I understand and accept any risks during and after my treatment. I hereby release the practitioner and facility from all liabilities associated with facial treatments performed by Aliya's Beauty.

I agree that this consent supersedes any previous verbal or written disclosure. This consent is valid for all of my facial treatments in the future as well.

I hereby consent to Aliya's Beauty taking photographs of the undersigned both before and after any procedures undertaken by Aliya's Beauty at the request of the undersigned. I understand these will be used to show others the results of these treatments and for Aliya's Beauty portfolio use.

Cancellation Policy

We understand that unexpected delays can occur and schedules sometimes need to be adjusted. If you need to cancel your appointment, we respectfully request at least 48 hours' notice.

Any cancellation or reschedule made less than 48 hours before the appointment will result in a cancellation fee equal to the cost of the reserved services. If you are more than 15 minutes late for your service, we may not be able to accommodate you, and the same cancellation fee may apply. We will do our very best to reschedule your service for another time that is convenient for you. Should we need to cancel your appointment, no cancellation fees will be charged to your card on file. In the event of a true, unavoidable emergency, part or all of your cancellation fee may be applied to future services.

Client Name (Printed)
Client Signature
Date
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Consent Forms
  • Brow Henna Consent Form
  • Brow Lamination Consent Form
  • Brow Wax & Tint Consent Form
  • Dermaplaning Consent Form
  • Lash Extensions Consent Form
  • Lash Lift Consent Form
  • Microneedling Consent Form
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Where To Find Us
  • 30 New Green Street
    South Shields
    NE33 5DL
    Tyne and Wear
    GB
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When We're Open
  • Monday:CLOSED
  • Tuesday:10:00-18:00
  • Wednesday:11:00-19:00
  • Thursday:08:45-12:00
  • Friday (TODAY):08:45-19:30
  • Saturday:10:00-19:30
  • Sunday:09:00-12:00
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