Wellness Wyns

Esthetician in Cartersville, GA

Luxury Client Intake & Consent

Personalized skin, wellness, and beauty experience. Complete each section, then sign below.

Client Information

Health History

Pregnant or Nursing?

Advanced Skin Analysis

Primary Concerns (check all that apply)
Skin Type (check all that apply)
Fitzpatrick Skin Type

How your skin reacts to sun: I always burns, never tans · II usually burns, tans lightly · III sometimes burns, tans evenly · IV rarely burns, tans well · V very rarely burns, tans darkly · VI never burns, deeply pigmented

Use Retinol?
Use Prescription Acne Products?
Previous Chemical Peels?
Previous Laser Treatments?
Previous Injectables?

Lifestyle & Wellness

Smoke or Vape?

Treatment Goals

What are your top 3 skincare goals?

Photo Release

I authorize Wellness Wyns to use before-and-after photos for educational and marketing purposes.

Photo release (required)

I understand that results vary and that I must disclose all relevant medical information.

I consent to recommended esthetic treatments and understand possible risks including redness, irritation, peeling, and sensitivity.

Client Signature (required)

Luxury Client Consent & Liability Waiver

I voluntarily consent to receive wellness, body sculpting, lymphatic drainage, massage, and skincare services from Wellness Wyns. I understand results vary and no guarantees are provided. I have disclosed all relevant medical conditions and agree to follow aftercare instructions.

Client Signature (required)

Completed forms are saved as a PDF to Wellness Wyns Google Drive. Drafts stay on this device.