Élan Beauty & Aesthetics

Pre-Treatment Consultation & Consent Form

Please complete this form prior to your appointment. This allows us to tailor your treatment to your unique needs while ensuring the highest level of care, safety, and results.

Personal Information

Ethnicity / Background (Optional)
(This helps us better understand your skin behaviour and response to treatment)

Coloured / Mixed Heritage

Indian / South Asian

Middle Eastern / North African

Indigenous / First Nations

(Skin Tone
(Select the closest match)

Very Fair (Porcelain, Ivory)

Fair (Light Beige, Cream)

Light (Soft Beige, Warm Ivory)

Light Medium (Golden Beige, Sand)

Medium (Olive, Honey)

Tan (Caramel, Warm Tan)

Medium Deep (Bronze, Chestnut)

Rich Deep (Espresso, Ebony)

Skin Type (Select all that apply)

Reactive / Easily Irritated

Treatment Preferences
Preferred Pressure Level

Élan Sculpting Ritual

Élan Lymphatic Glow Therapy

Élan Buccal Sculpt & Contour Ritual

Élan Signature Glow Facial

Élan Ultimate All-in-One Experience

Élan Dual Agate Sculpt Facial

Élan Tension Release Add-On

Élan Deep Cleansing Treatment

Élan Brightening Glow Treatment

Medical & Treatment History

Have you received Botox, dermal fillers, facial surgery, or experienced reactions to injectables?

If yes, please provide details (areas & dates):

Do you have any known allergies? *

If yes, please list:

Are you currently taking any medication?

If yes, please state or type 0 if not.

Do you have any medical conditions we should be aware of?

If yes, please specify:

Skin Concerns

(Select all that apply)

Client Goals

What would you like to achieve from your treatment?

Reduce expression wrinkles

Remove nasolabial folds

Brightening pigmentation

Discovery

How did you hear about Élan Beauty & Aesthetics?

Word of Mouth 🗣️

Other – please specify where below:

Consent & Agreement

Consent to Treatment

I understand that all treatments at Élan Beauty & Aesthetics are performed for cosmetic and relaxation purposes only and are not intended to diagnose or treat any medical condition.

I acknowledge that results vary from person to person and cannot be guaranteed.

I understand that while all treatments are performed with the highest level of care, I may experience temporary reactions including redness, sensitivity, breakouts, swelling, or irritation.

I confirm that I have disclosed all relevant medical history, allergies, medications, and skin conditions truthfully.

I understand that if I have received Botox, dermal fillers, or other injectable treatments, a minimum waiting period of 3 weeks (21 days) is recommended before advanced facial treatments. Should I proceed within this period, I accept full responsibility for any associated risks.

I agree to the Terms & Conditions *

Élan Beauty & Aesthetics

Pre-Treatment Consultation & Consent Form

Full Name & Surname

Date of birth

Phone number:

Email address

Personal Profile

Gender

Ethnicity / Background (Optional)
(This helps us better understand your skin behaviour and response to treatment)

Skin Assessment

(Skin Tone
(Select the closest match)

Skin Type (Select all that apply)

Treatment Preferences
Preferred Pressure Level

Selected Treatment

Medical & Treatment History

Have you received Botox, dermal fillers, facial surgery, or experienced reactions to injectables?

If yes, please provide details (areas & dates):

Do you have any known allergies? *

If yes, please list:

Are you currently taking any medication?

If yes, please state or type 0 if not.

Do you have any medical conditions we should be aware of?

If yes, please specify:

Skin Concerns

(Select all that apply)

Client Goals

What would you like to achieve from your treatment?

Discovery

How did you hear about Élan Beauty & Aesthetics?

Other – please specify where below:

Signature

Élan Beauty & AestheticsPre-Treatment Consultation & Consent Form

Full Name & Surname

Date of birth

Phone number:

Email address

Personal Profile

Gender

Ethnicity / Background (Optional)(This helps us better understand your skin behaviour and response to treatment)

Skin Assessment

(Skin Tone(Select the closest match)

Skin Type (Select all that apply)

Treatment PreferencesPreferred Pressure Level

Selected Treatment

Medical & Treatment HistoryHave you received Botox, dermal fillers, facial surgery, or experienced reactions to injectables?

If yes, please provide details (areas & dates):

Do you have any known allergies? *

If yes, please list:

Are you currently taking any medication?

If yes, please state or type 0 if not.

Do you have any medical conditions we should be aware of?

If yes, please specify:

Skin Concerns(Select all that apply)

Client GoalsWhat would you like to achieve from your treatment?

DiscoveryHow did you hear about Élan Beauty & Aesthetics?

Other – please specify where below:

Signature

Élan Beauty & Aesthetics

Pre-Treatment Consultation & Consent Form

Ethnicity / Background (Optional)
(This helps us better understand your skin behaviour and response to treatment)

(Skin Tone
(Select the closest match)

Treatment Preferences
Preferred Pressure Level

Medical & Treatment History

Have you received Botox, dermal fillers, facial surgery, or experienced reactions to injectables?

Skin Concerns

(Select all that apply)

Client Goals

What would you like to achieve from your treatment?

Discovery

How did you hear about Élan Beauty & Aesthetics?