Tanning Consultation/Consent Form | Beauty Forms Portal

Tanning Consultation and Consent Form

Client Details

Full Name: *

Date of Birth: *

Contact Number: *

Email: *

Please upload a clear image of proof-of-age documentation: *

Health Information

Are you currently taking any medications? *

Please list: *

Do you have any allergies? *

Please list: *

Have you recently been unwell? *

Which of the following were you unwell with? *

Please provide more detail: *

Emergency Contact Details

Emergency Contact Name: *

Emergency Contact Phone: *

Emergency Contact Relationship: *

Tanning Hazards Information

What is “tanning”?
Tanning is the body’s response when your skin is exposed to ultraviolet (UV) radiation. The skin becomes damaged and produces extra pigment to protect itself against the UV radiation. This pigment makes the skin look darker.

What is UV radiation?
UV radiation is a form of energy from natural sunlight or from a tanning device such as a sunlamp, tanning booth or tanning bed that is not visible to the human eye. It is classified as carcinogenic to humans and can cause cancer.

What are the potential health risks associated with tanning?
- Skin cancer
- Burns and injury to the skin and eyes
- Premature aging of the skin
- Allergic reactions
- Worsen existing medical conditions
- Immune suppression

Factors that put you at increased risk for developing skin cancer:
- Lighter natural skin
- Family or personal history of skin cancer
- History of sunburn early in life
- Skin that burns, freckles, reddens easily, or is painful in the sun
- Blue or green eyes and blond or red hair
- Certain types and/or a large number of moles

Are indoor tanning devices safer than tanning in natural sunlight?
No. The UV radiation produced by indoor tanning devices can cause the same damage to the skin as natural sunlight. Exposure to UV radiation, whether from an indoor tanning device or from natural sunlight, increases health risks for everyone

Avoid indoor tanning if:
- You burn easily and don’t usually tan in natural sunlight.
- You get frequent cold sores. UV radiation can lead to common light-sensitive ailments.
- You have medical conditions like lupus and vitiligo. UV radiation can worsen symptoms.
- You are immune suppressed. UV radiation can be more hazardous.
- You eat certain foods or use certain cosmetics or medications that can make your skin burn more easily. This reaction is called “photosensitivity.” Ask the tanning facility operator or employee for a list of these items.

For persons who choose to expose themselves to UV radiation from indoor tanning devices:
- Always wear FDA certified protective eyewear. If you don’t have your own FDA certified protective eyewear,request it from the tanning facility operator or employee.
- Learn your skin type and understand the exposure limits recommended by the manufacturer of the tanning device.
- Seek medical attention for severe burns, allergic reactions and unusual skin lesions or sores.
- Report any injuries or adverse reactions promptly to the tanning facility operator or employee.

Statement of Acknowledgement

ULTRAVIOLET RADIATION
Ultraviolet (UV) radiation is a human carcinogen and can cause skin cancer. Overexposure to UV radiation from tanning devices can cause burns and injury to the skin and eyes, premature aging of the skin and allergic reactions. Overexposure to UV radiation can reduce immunity, making your body less able to fight infection. It can also worsen existing medical conditions.
I will not exceed the manufacturer's maximum exposure time when using a tanning device.

ULTRAVIOLET RADIATION SENSITIVITY
A combination of UV radiation and certain foods, cosmetics or medications can increase sensitivity to UV radiation. This is called “photosensitivity”.
I am aware that the use of UV radiation is not advised when eating certain foods or when using certain cosmetics or medications. I will consult a physician before using a tanning device if I am using photosensitive medications, have a history of skin problems or if I believe I am especially sensitive to sunlight. I am aware that if I do not tan in the sun, I am unlikely to tan from the use of a tanning device.

TANNING HAZARDS INFORMATION
I have read the Tanning Hazards Information provided in this form.

PROTECTIVE EYEWEAR
Failure to use Food and Drug Administration (FDA) certified protective eyewear can result in severe burns or injury to the eye, such as photokeratitis, cataracts, macular degeneration and melanoma.
I agree to wear FDA certified protective eyewear.

STATEMENT OF ACKNOWLEDGEMENT
I have been given adequate instruction in the operation and use of tanning devices.
I have read and understand the hazards of tanning so that I can make an informed judgment about indoor tanning and the use of tanning devices.
I verify that I am 18 years of age or older.

By my electronic signature below I acknowledge that I have read and fully understand this agreement and all the information detailed above. *

Tap or click on the signature above to sign