Shimmer of Hope

Client Consultation Form

Client Information and Consent

Please fill out the form below to schedule an appointment or to contact us.

Name*

Date of Birth*

Occupation

Address

City

ZIP Code

Phone*

Email*

MEDICAL HISTORY Yes No

1. Have you ever had a spray tan before?*

2. Have you ever had an allergic reaction to a cosmetic or skincare product?*

3. Do you have any open cuts, wounds or skin infections?*

4. Have you recently used any skincare products containing retinoids or alpha hydroxy acids?*

5. Do you have any respiratory issues such as asthma or breathing difficulties?*

What color shade would you like your tan to be? (Light, Medium, Dark) * Do you have any special events or occasions for which you are getting the spray tan? * Have you used a tanning bed or spent extended time in the sun recently? * Any additional information I need to know? Comments, questions, concerns?