Boujie and Bare Esthetics

Client safety and consent

Intake, allergy screening, and release form

Please answer every applicable question accurately. Your information helps determine whether a service should proceed, be modified, or be rescheduled for your safety.

Secure submission This form submits directly and securely to Boujie and Bare. Your information is encrypted before it is stored.
01

Start here

Are you a new or returning client?

02

Client information

Contact and appointment details

03

Required safety screening

Allergies and prior reactions

Natural and organic does not mean allergy-free.

Products may contain fruit, nut, seed, plant, botanical, honey, beeswax, propolis, pollen, enzyme, essential-oil, fragrance, preservative, or latex-derived ingredients.

Do you have any known or suspected allergies?

Select every category that applies

Specific fruit and enzyme allergies

Specific nut allergies

04

Health history

Conditions, medications, and contraindications

Select every item that currently applies or has recently applied. Additional details can be entered below.

05

Recent services

Procedures and skin changes

06

Required acknowledgment

Treatment consent

07

Separate optional permission

Photo and social-media release

Your treatment is not conditioned on public photo permission. Choose one option.

08

Separate optional permission

Marketing communication

Appointment confirmations and necessary service communications are separate from promotional consent.

09

Electronic signature

Review and sign

Your information is encrypted before it is stored. Fields marked as required must be completed before submitting.

Questions about a product or allergy?Call or text 916-871-9400 before your appointment.