Client Consent & Intake Form

Please complete the information below before your session. This helps us keep your experience safe, smooth, and personalized.

Client Information

Full Name:
Date of Birth:
Age: 18+ required
Phone Number:
Email Address:
Plan Type:
Start Date:

Membership Policies

Unlimited UV memberships allow a maximum of 1 session per week.

Please review the following policies before booking:

Sessions must follow a 7-day minimum interval between appointments.
Missed sessions do not roll over.
Late arrivals beyond 10 minutes may need to be rescheduled.
Memberships are non-transferable and non-refundable.
Proper aftercare must be followed for the best results.

Health & Treatment Questionnaire

Please answer yes or no to the following:

Are you pregnant or breastfeeding?
Do you have melasma or hyperpigmentation?
Have you had laser treatment in the last 7 days?
Do you plan to have laser treatment within 7 days after tanning?
Have you used UV tanning in the last 7 days?
Are you using retinol, tretinoin, or exfoliating products?
Are you taking photosensitive medications?
Do you have any skin conditions or cosmetic allergies?
Have you gotten any recent tattoos within the last 2 weeks?
Have you exfoliated in the last 24 hours?

Client Agreement & Acknowledgment

I confirm that all information I have provided is true and accurate. I understand that UV tanning involves controlled exposure to ultraviolet light and carries potential risks, including skin sensitivity, redness, burns, irritation, uneven results, and other skin reactions.

I acknowledge that individual results may vary depending on skin type, medical history, lifestyle, and adherence to preparation and aftercare instructions. I understand that a minimum 7-day interval is required between UV tanning sessions, and I agree to follow all timing, safety, and aftercare guidelines provided by Kanella.

I understand that proper hydration, skincare, and aftercare are essential for optimal results.

If I am using retinol, exfoliating acids, tretinoin, or similar products, I agree to apply facial sunscreen and keep the facial shield fully lowered during UV tanning sessions. I understand that failure to properly use facial protection may increase the risk of uneven pigmentation, irritation, or skin sensitivity. Kanella is not responsible for outcomes resulting from failure to follow provided instructions or safety guidelines.

I understand that protective eyewear is required during all UV tanning sessions, and I agree to wear the protective eyewear provided or approved by Kanella at all times during exposure.

I confirm that I do not have any laser treatments scheduled within 7 days before or after my tanning session.

I confirm that I am not pregnant and do not have any medical conditions or take any medications that would make UV exposure unsafe. If I am unsure, I agree to consult with a physician before proceeding.

I confirm that I am at least 18 years of age.

I understand that Kanella reserves the right to refuse service if contraindications, safety concerns, skin conditions, or other risk factors are identified before or during the appointment.

By signing below, I acknowledge that I have read and understood this agreement, had the opportunity to ask questions, and voluntarily accept the potential risks associated with UV tanning services.

Consent

By submitting this form, I confirm that the information provided is accurate to the best of my knowledge. I understand that it is my responsibility to disclose any skin concerns, allergies, medications, recent treatments, or conditions that may affect my tanning results or safety.

I also understand and agree to Kanella’s membership policies, including appointment spacing, late arrival guidelines, and aftercare requirements.

Client Signature:
Date: