Facial & Advanced Skincare Treatment Consent Form

First Name *

Last Name *

Email *

Cell Phone

City

Date of birth

How did you learn about JU-ENE? *

Emergency Contact Full Name

Emergency Contact Phone Number:

Emergency Contact Relationship:

Treatment Descriptions & Key Information

Facial / Buccal Massage:
A deep muscle facial massage, including intraoral (buccal) work, designed to lift and sculpt the face naturally.

Hydrodermabrasion:
A gentle water-based exfoliation and hydration treatment that brightens skin with minimal downtime.

Dermaplaning:
A non-invasive exfoliation that removes dead skin cells and vellus hair using a sterile blade for smooth texture.

Chemical Peel:
A solution applied to exfoliate and rejuvenate skin, improving tone and reducing blemishes or fine lines.

Somatic Facial Massage:
Gentle mindful touch focusing on tension release and emotional well-being through face, neck, and scalp massage.

Current Skincare/Treatments/Medications we should be aware of?

I acknowledge the importance of disclosing all medical conditions and medications to my massage therapist and informing them of any changes. I understand that additional risks may arise based on my physical condition

I take responsibility for communicating any discomfort experienced during the massage session so that adjustments can be made accordingly.

Treatment Type

Please select the service(s) you are receiving today: A Somatic Facial Massage involves gentle, mindful touch applied to the muscles of your face, neck, jaw, and scalp. This treatment aims to release tension, promote relaxation, and help you reconnect with your body through heightened awareness of physical sensations and breath. You may experience both physical and emotional responses during or after the session, including emotional release or changes in mood.

Please check box to confirm

I acknowledge that either I or the massage therapist may terminate the session at any time. I have had the opportunity to seek clarification by asking questions about the massage therapy sessions, and my inquiries have been adequately addressed.

De-Identified Photos?

Yes

Acknowledgment & Liability Release

By signing below, I confirm that:

I voluntarily consent to receive treatment(s) provided by Ju-ene Beauty & Wellness.
I understand that results vary and no guarantees are made.
I will communicate any discomfort or adverse reactions during the session.
I release Ju-ene Beauty & Wellness, its employees, and practitioners from any liability related to the treatment(s).
Either I or the practitioner may end the session at any time.
I have read, understood, and had the opportunity to ask questions regarding this consent form.

Client Signature

Clear