Private & Confidential Client Treatment Record  

Client Ref:  

Date:  

Have there been any changes to your circumstances, medication, or general health since your last treatment? Comments:  

Shield size: Timing: Results:  

Yes/No  

Small Medium Large 

Lifting lotion ............... Fixer ...............  

Client declaration: I declare that the information I have given is correct and to the best of my knowledge I can undertake treatments without any adverse effect. I have been fully informed about contra-indications and I am therefore willing to proceed with treatment.  

Signed (Client):  

Date:  

Date:  

Have there been any changes to your circumstances, medication, or general health since your last treatment? Comments: Shield size:  

Timing: Results:  

Yes/No  

Small Medium Large 

Lifting lotion ............... Fixer ...............  

Client declaration: I declare that the information I have given is correct and to the best of my knowledge I can undertake treatments without any adverse effect. I have been fully informed about contra-indications and I am therefore willing to proceed with treatment.  

Signed (Client):  

Date:  

Date: 

Have there been any changes to your circumstances, medication, or general health since your last treatment? Comments: Shield size: Timing:  

Results:  

Yes/No  

Small Medium Large 

Lifting lotion ............... Fixer ...............  

Client declaration: I declare that the information I have given is correct and to the best of my knowledge I can undertake treatments without any adverse effect. I have been fully informed about contra-indications and I am therefore willing to proceed with treatment.  

Signed (Client):  

Date: