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Consultation Form

This is a General Consultation Form for all treatments booked at Elysium Beauty Club. On average this form takes 6 minutes to complete.

Please let me know about any pre-existing health conditions, allergies, medications, or other medical concerns—even if they don’t seem relevant. Some conditions or medications may prevent certain treatments from being carried out safely.

I reserve the right to refuse or adapt a treatment if I believe it may be unsafe or unsuitable. Your answers will help me tailor the treatment to your needs and avoid any risks.

Your honesty and cooperation are greatly appreciated.

- Step 1 of 3

Contact details

First name *

Last name *

Date of birth *

Address line 1

Town/City *

E-mail address *

Telephone number *

Preferred Contact Method(s) *

Telephone
E-mail
What's App
Text Message

Let us know the best way to contact you, you can choose more than 1 contact method.

Which treatment did you book? *

Face Massage/Facial
Body Massage
Waxing

Questionaire

Do you have any medical conditions, diagnoses or issues? *

Please detail any medical conditions, diagnoses or issues below *

Do you currently take any medications, supplements, or herbal remedies? Please include all, even if they don’t seem relevant. *

List all medications, supplements, or herbal remedies you currently take

Do you have any allergies/sensitivities? *

Please list any allergies or sensitivities you have, and describe how your body typically reacts to them *

Have you had any injectable aesthetics? *

When was your last injectable aesthetics treatment? *

Have you had any past injuries or surgeries? *

Please provide details or your injury/surgery

Have you had this treatment before? *

Yes, I have this treatment before
No, it is my first time

When was the last time you received this treatment? *

What results are you hoping to achieve from this treatment? *

(Please share any specific concerns or goals you have in mind.)

Marketing info

Would you like to join my client mailing list to receive updates on new treatments, special offers, and newsletters?

Yes, sign me up please
No, thank you

Stay in the loop! If you’d like to receive updates about new treatments, exclusive offers, and newsletters, please opt in below. Messages may be sent via email, SMS, or WhatsApp, depending on your contact preferences.

How did you hear about Elysium Beauty Club? *

Google
Facebook
Instagram
Recommendation
Sign
Leaflet
Returning customer
Other social media platform
Other search engine
Seen the shop

We’d love to know how you found us! Please let us know how you first heard about Elysium Beauty Club. This helps us understand which platforms and referrals are reaching new clients.

Consent section

Do you consent to before & after photos being taken and used for marketing purposes? *

Yes
No
Yes but anonymised

Please read and confirm the following before proceeding. These statements ensure you understand your responsibilities, the nature of the treatment, and how your information will be handled. All treatments are carried out with your safety and wellbeing in mind.

I confirm that the information I've provided is true and complete. I understand it's my responsibility to inform my therapist of any changes to my health, allergies, medications or conditions before each treatment.
I accept that treatments are not a substitute for medical care and agree that I have disclosed anything that might affect my treatment. I take full responsibility for any issues that arise from information I have withheld.
I give consent to receive treatment and understand I can stop at any time. My data will be stored securely and never shared without my permission.

Discover the true meaning of pampering at Elysium Beauty Club. Your sanctuary awaits.

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