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BOOK NOW
Face massage
Additional massage
Facial care
Hydration and nourishing
Deep cleansing
Renewal and radiance
All facial procedures
Home
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Face massage
Additional massage
Facial care
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Face Style Bar – a destination
for care and self-love
BOOK NOW
+1 (720) 427-8550
Please ensure the form is completed before the appointment
1. CLIENT INFORMATION:
Name
Age
Gender
Contact number
+1
Afghanistan (افغانستان)
+93
Albania (Shqipëri)
+355
Algeria (الجزائر)
+213
Andorra
+376
Angola
+244
Armenia (Հայաստան)
+374
Antigua and Barbuda
+1 (268)
Argentina
+54
Australia
+61
Austria (Österreich)
+43
Azerbaijan (Azərbaycan)
+994
Bahamas
+1 (242)
Bahrain (البحرين)
+973
Bangladesh (বাংলাদেশ)
+880
Barbados
+1 (246)
Belarus (Беларусь)
+375
Belgium (België)
+32
Belize
+501
Benin (Bénin)
+229
Bhutan (འབྲུག)
+975
Bolivia
+591
Bosnia and Herzegovina
+387
Botswana
+267
Brazil (Brasil)
+55
Brunei
+673
Bulgaria (България)
+359
Burkina Faso
+226
Burundi (Uburundi)
+257
Cambodia (កម្ពុជា)
+855
Cameroon (Cameroun)
+237
Canada
+1
Cape Verde (Kabu Verdi)
+238
Caribbean Netherlands
+599
Cayman Islands
+1
Central African Republic (République centrafricaine)
+236
Chad (Tchad)
+235
Chile
+56
China (中国)
+86
Colombia
+57
Comoros (جزر القمر)
+269
Congo (DRC) (Jamhuri ya Kidemokrasia ya Kongo)
+243
Congo (Republic) (Congo-Brazzaville)
+242
Cook Islands
+682
Costa Rica
+506
Cote d’Ivoire
+225
Croatia (Hrvatska)
+385
Cuba
+53
Cyprus (Κύπρος)
+357
Czech Republic (Česká republika)
+420
Denmark (Danmark)
+45
Djibouti
+253
Dominica
+1 (767)
Dominican Republic (República Dominicana)
+1
Ecuador
+593
Egypt (مصر)
+20
El Salvador
+503
Equatorial Guinea (Guinea Ecuatorial)
+240
Eritrea
+291
Estonia (Eesti)
+372
Ethiopia
+251
Fiji
+679
Finland (Suomi)
+358
France
+33
Gabon
+241
Gambia
+220
Georgia (საქართველო)
+995
Germany (Deutschland)
+49
Ghana (Gaana)
+233
Greece (Ελλάδα)
+30
Grenada
+1 (473)
Guatemala
+502
Guinea (Guinée)
+224
Guinea-Bissau (Guiné Bissau)
+245
Guyana
+592
Haiti
+509
Honduras
+504
Hong Kong (香港)
+852
Hungary (Magyarország)
+36
Iceland (Ísland)
+354
India (भारत)
+91
Indonesia
+62
Iran (ایران)
+98
Iraq (العراق)
+964
Ireland
+353
Israel (ישראל)
+972
Italy (Italia)
+39
Jamaica
+1
Japan (日本)
+81
Jordan (الأردن)
+962
Kazakhstan (Казахстан)
+7
Kenya
+254
Kiribati
+686
Kosovo (Republic)
+383
Kuwait (الكويت)
+965
Kyrgyzstan (Кыргызстан)
+996
Laos (ລາວ)
+856
Latvia (Latvija)
+371
Lebanon (لبنان)
+961
Lesotho
+266
Liberia
+231
Libya (ليبيا)
+218
Liechtenstein
+423
Lithuania (Lietuva)
+370
Luxembourg
+352
Macao
+853
Macedonia (FYROM) (Македонија)
+389
Madagascar (Madagasikara)
+261
Malawi
+265
Malaysia
+60
Maldives
+960
Mali
+223
Malta
+356
Marshall Islands
+692
Mauritania (موريتانيا)
+222
Mauritius (Moris)
+230
Mexico (México)
+52
Mexico (México)
+521
Micronesia
+691
Moldova (Republica Moldova)
+373
Monaco
+377
Mongolia (Монгол)
+976
Montenegro (Crna Gora)
+382
Morocco (المغرب)
+212
Mozambique (Moçambique)
+258
Myanmar (Burma) (မြန်မာ)
+95
Namibia (Namibië)
+264
Nauru
+674
Nepal (नेपाल)
+977
Netherlands (Nederland)
+31
New Caledonia
+687
New Zealand
+64
Nicaragua
+505
Niger (Nijar)
+227
Nigeria
+234
Niue
+683
North Korea (조선 민주주의 인민 공화국)
+850
Norway (Norge)
+47
Oman (عُمان)
+968
Panama
+507
Pakistan (پاکستان)
+92
Palau
+680
Palestinian Territory
+970
Papua New Guinea
+675
Paraguay
+595
Peru (Perú)
+51
Philippines
+63
Poland (Polska)
+48
Portugal
+351
Qatar (قطر)
+974
Romania (România)
+40
Russian Federation (Российская Федерация)
+7
Rwanda
+250
Saint Kitts and Nevis
+1 (869)
Saint Lucia
+1 (758)
Saint Vincent and the Grenadines
+1 (784)
Samoa
+685
San Marino
+378
Sao Tome and Principe (São Tomé e Príncipe)
+239
Saudi Arabia (المملكة العربية السعودية)
+966
Senegal (Sénégal)
+221
Serbia (Србија)
+381
Seychelles
+248
Sierra Leone
+232
Singapore
+65
Slovakia (Slovensko)
+421
Slovenia (Slovenija)
+386
Solomon Islands
+677
Somalia (Soomaaliya)
+252
South Africa
+27
South Korea (대한민국)
+82
South Sudan (جنوب السودان)
+211
Spain (España)
+34
Sri Lanka (ශ්රී ලංකාව)
+94
Sudan (السودان)
+249
Suriname
+597
Swaziland
+268
Sweden (Sverige)
+46
Switzerland (Schweiz)
+41
Syria (سوريا)
+963
Taiwan (台灣)
+886
Tajikistan
+992
Tanzania
+255
Thailand (ไทย)
+66
Togo
+228
Tonga
+676
Trinidad and Tobago
+1 (868)
Tunisia (تونس)
+216
Turkey (Türkiye)
+90
Turkmenistan
+993
Tuvalu
+688
Uganda
+256
Ukraine (Україна)
+380
United Arab Emirates (الإمارات العربية المتحدة)
+971
United Kingdom
+44
USA
+1
Uruguay
+598
Uzbekistan (Oʻzbekiston)
+998
Vanuatu
+678
Vatican City (Città del Vaticano)
+39
Venezuela
+58
Vietnam (Việt Nam)
+84
Yemen (اليمن)
+967
Zambia
+260
Zimbabwe
+263
Email address
2. SKIN CONCERNS:
1. What are your primary skin concerns? (Check all that apply)
Acne
Aging/Wrinkles
Oiliness
Sensitivity/redness
Uneven skin tone
Other (please specify)
2. Have you experienced any recent changes in your skin? (e.g., breakouts, dry patches, increased sensitivity)
3. MEDICAL HISTORY:
1. Do you have any known allergies? If yes, please specify:
2. Have you undergone any resent (past 6 months) skin treatments or surgeries?
3. Are you currently taking any medications or undergoing any medical treatments? If yes, please specify:
4. Are you currently pregnant?
YES
NO
5. Are you currently breastfeeding?
YES
NO
6. Do you have any known thyroid conditions?
YES
NO
4. TREATMENT PREFERENCES:
1. What specific results are you hoping to achieve from Face style bar skin care treatment?
2. Are you open to trying new products or treatments during your session?
3. Do you have any preferences regarding skincare products?
I, declare that I am of legal age and of sound mind. I have carefully read and fully understand the terms outlined in this consent form. I confirm that I have been provided with a clear explanation of the treatment I am about to receive, including its benefits, risks, and any potential complications.
I acknowledge that I have had the opportunity to ask questions, and all my concerns have been addressed to my satisfaction. I understand that withholding information or providing misinformation regarding my health history may impact the outcome of the treatment and could result in adverse reactions.
I confirm that I have provided accurate information regarding my health history and any medications or treatments I am currently undergoing. I understand that it is my responsibility to inform the esthetician of any changes to my health status that may affect the treatment.
I agree to follow all pre and post-treatment care instructions provided to me by the esthetician. I understand that failure to comply with these instructions may increase the risk of complications and affect the outcome of the treatment.
By signing below, I release Face Style. Bar and its staff from all liability for any injuries or complications that may occur during or following the treatment. I accept full responsibility for any adverse reactions or complications that may arise as a result of the treatment.
Emergency contact information:
Name
Phone number
+1
Afghanistan (افغانستان)
+93
Albania (Shqipëri)
+355
Algeria (الجزائر)
+213
Andorra
+376
Angola
+244
Armenia (Հայաստան)
+374
Antigua and Barbuda
+1 (268)
Argentina
+54
Australia
+61
Austria (Österreich)
+43
Azerbaijan (Azərbaycan)
+994
Bahamas
+1 (242)
Bahrain (البحرين)
+973
Bangladesh (বাংলাদেশ)
+880
Barbados
+1 (246)
Belarus (Беларусь)
+375
Belgium (België)
+32
Belize
+501
Benin (Bénin)
+229
Bhutan (འབྲུག)
+975
Bolivia
+591
Bosnia and Herzegovina
+387
Botswana
+267
Brazil (Brasil)
+55
Brunei
+673
Bulgaria (България)
+359
Burkina Faso
+226
Burundi (Uburundi)
+257
Cambodia (កម្ពុជា)
+855
Cameroon (Cameroun)
+237
Canada
+1
Cape Verde (Kabu Verdi)
+238
Caribbean Netherlands
+599
Cayman Islands
+1
Central African Republic (République centrafricaine)
+236
Chad (Tchad)
+235
Chile
+56
China (中国)
+86
Colombia
+57
Comoros (جزر القمر)
+269
Congo (DRC) (Jamhuri ya Kidemokrasia ya Kongo)
+243
Congo (Republic) (Congo-Brazzaville)
+242
Cook Islands
+682
Costa Rica
+506
Cote d’Ivoire
+225
Croatia (Hrvatska)
+385
Cuba
+53
Cyprus (Κύπρος)
+357
Czech Republic (Česká republika)
+420
Denmark (Danmark)
+45
Djibouti
+253
Dominica
+1 (767)
Dominican Republic (República Dominicana)
+1
Ecuador
+593
Egypt (مصر)
+20
El Salvador
+503
Equatorial Guinea (Guinea Ecuatorial)
+240
Eritrea
+291
Estonia (Eesti)
+372
Ethiopia
+251
Fiji
+679
Finland (Suomi)
+358
France
+33
Gabon
+241
Gambia
+220
Georgia (საქართველო)
+995
Germany (Deutschland)
+49
Ghana (Gaana)
+233
Greece (Ελλάδα)
+30
Grenada
+1 (473)
Guatemala
+502
Guinea (Guinée)
+224
Guinea-Bissau (Guiné Bissau)
+245
Guyana
+592
Haiti
+509
Honduras
+504
Hong Kong (香港)
+852
Hungary (Magyarország)
+36
Iceland (Ísland)
+354
India (भारत)
+91
Indonesia
+62
Iran (ایران)
+98
Iraq (العراق)
+964
Ireland
+353
Israel (ישראל)
+972
Italy (Italia)
+39
Jamaica
+1
Japan (日本)
+81
Jordan (الأردن)
+962
Kazakhstan (Казахстан)
+7
Kenya
+254
Kiribati
+686
Kosovo (Republic)
+383
Kuwait (الكويت)
+965
Kyrgyzstan (Кыргызстан)
+996
Laos (ລາວ)
+856
Latvia (Latvija)
+371
Lebanon (لبنان)
+961
Lesotho
+266
Liberia
+231
Libya (ليبيا)
+218
Liechtenstein
+423
Lithuania (Lietuva)
+370
Luxembourg
+352
Macao
+853
Macedonia (FYROM) (Македонија)
+389
Madagascar (Madagasikara)
+261
Malawi
+265
Malaysia
+60
Maldives
+960
Mali
+223
Malta
+356
Marshall Islands
+692
Mauritania (موريتانيا)
+222
Mauritius (Moris)
+230
Mexico (México)
+52
Mexico (México)
+521
Micronesia
+691
Moldova (Republica Moldova)
+373
Monaco
+377
Mongolia (Монгол)
+976
Montenegro (Crna Gora)
+382
Morocco (المغرب)
+212
Mozambique (Moçambique)
+258
Myanmar (Burma) (မြန်မာ)
+95
Namibia (Namibië)
+264
Nauru
+674
Nepal (नेपाल)
+977
Netherlands (Nederland)
+31
New Caledonia
+687
New Zealand
+64
Nicaragua
+505
Niger (Nijar)
+227
Nigeria
+234
Niue
+683
North Korea (조선 민주주의 인민 공화국)
+850
Norway (Norge)
+47
Oman (عُمان)
+968
Panama
+507
Pakistan (پاکستان)
+92
Palau
+680
Palestinian Territory
+970
Papua New Guinea
+675
Paraguay
+595
Peru (Perú)
+51
Philippines
+63
Poland (Polska)
+48
Portugal
+351
Qatar (قطر)
+974
Romania (România)
+40
Russian Federation (Российская Федерация)
+7
Rwanda
+250
Saint Kitts and Nevis
+1 (869)
Saint Lucia
+1 (758)
Saint Vincent and the Grenadines
+1 (784)
Samoa
+685
San Marino
+378
Sao Tome and Principe (São Tomé e Príncipe)
+239
Saudi Arabia (المملكة العربية السعودية)
+966
Senegal (Sénégal)
+221
Serbia (Србија)
+381
Seychelles
+248
Sierra Leone
+232
Singapore
+65
Slovakia (Slovensko)
+421
Slovenia (Slovenija)
+386
Solomon Islands
+677
Somalia (Soomaaliya)
+252
South Africa
+27
South Korea (대한민국)
+82
South Sudan (جنوب السودان)
+211
Spain (España)
+34
Sri Lanka (ශ්රී ලංකාව)
+94
Sudan (السودان)
+249
Suriname
+597
Swaziland
+268
Sweden (Sverige)
+46
Switzerland (Schweiz)
+41
Syria (سوريا)
+963
Taiwan (台灣)
+886
Tajikistan
+992
Tanzania
+255
Thailand (ไทย)
+66
Togo
+228
Tonga
+676
Trinidad and Tobago
+1 (868)
Tunisia (تونس)
+216
Turkey (Türkiye)
+90
Turkmenistan
+993
Tuvalu
+688
Uganda
+256
Ukraine (Україна)
+380
United Arab Emirates (الإمارات العربية المتحدة)
+971
United Kingdom
+44
USA
+1
Uruguay
+598
Uzbekistan (Oʻzbekiston)
+998
Vanuatu
+678
Vatican City (Città del Vaticano)
+39
Venezuela
+58
Vietnam (Việt Nam)
+84
Yemen (اليمن)
+967
Zambia
+260
Zimbabwe
+263
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