Name *

First Name

Last Name

Do you currently have, or have you had within the last 14 days any flu-like symptoms (fever, dry cough, tiredness, shortness of breath, sore throat, aches & pains, runny nose, congestion)? *

No

Yes

Have you had contact with any person in the last 14 days who you believe may have displayed flu-like symptoms (fever, dry cough, tiredness, shortness of breath, sore throat, aches & pains, runny nose, congestion)? *

No

Yes

Have you or any person close to you returned from overseas air or sea travel in the last 14 days? *

No

Yes

Are you pregnant? *

No

Yes

Do you smoke? *

No

Yes

Have you had cosmetic injectables recently? *

No

Yes

Are you using? *

Retin-A

Roaccutane

Antibiotics that may affect your treatments

Are you using tanning booths? *

No

Yes

Have you ever had an allergic reaction to any beauty/cosmetic treatment you are about to have? *

No

Yes

Do you have any allergies? *

No

Yes

Would you like 1O1 Darley Beauty Collective / Serious Skincare Society to perform an Allergy patch test before your treatment? *

No

Yes

Have you ever had a bad experience that you are still concerned about? *

No

Yes

Facial Treatments: (Indicate areas of concern): *

Normal

Oily

Dry

T-Zone

Combination

Acne

Uneven / Blotchy

Rosacea

Hyper-pigmented

Broken Capillaries

Sun-damaged

Saggy

Sensitive

I accept all terms and conditions including the following: *

I understand that the treatments provided by Serious Skincare Society & 1O1 Darley Beauty Collective are designed to improve skin health and appearance. I acknowledge that: Results may vary depending on my skin type, lifestyle, and adherence to aftercare instructions. Temporary side effects such as redness, swelling, or sensitivity may occur. I must inform my therapist of any changes to my medical history before future treatments. Serious Skincare Society & 1O1 Darley Beauty Collective are not responsible for adverse reactions due to undisclosed medical conditions or allergies. I have had the opportunity to ask questions and fully understand the treatment being provided. By ticking this box, I also accept 1O1 Darley's / Serious Skincare Society's booking / cancellation policy.

Yes

I acknowledge results may vary. *

Yes