CLIENT CONSENT FORM

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Please fill out the following form to help me understand a little more about you.

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DO YOU HAVE ANY ALLERGIES?

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Yes

ARE YOU CURRENTLY TAKING ANY PERSCRIBED MEDICATIONS?

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DESCRIBE YOUR PHYSICAL AND EMOTIONAL / MENTAL HEALTH

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ARE YOU PREGNANT OR BREASTFEEDING?

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DESCRIBE YOUR SKIN AT THIS TIME

WHAT IS YOUR GOAL FOR THIS CONSULTATION?

By checking this box, I have read the Informed Consent and I hereby give my permission for Jessica Sheridan to design an aromatic program for me based upon my unique needs and goals.View Informed Consent.

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