Chemical Service Consent Form

You are now being redirected to the necessary forms needed to be filled out for your appointment, if you have previously filled this form out please disregard..

If any of these apply to you, they do count as an unfortunate contradiction from receiving the service please refer back to email and please click the link to cancel appointment request or immediately contact me if your willing to take the chance…
Please be aware contact lenses are not suggested for wearing at time of appointment, Medication use, Skin conditions etc by manufactures rules, also these are the basics pre-op appointment questions to ask by the manufacture themselves, if there is any added info i must know before please let me know

Florida Statues Title XXXll Chapter 477.013 Board of Cosmetology

Here in the state of Florida, it is required to be licensed and insured, within the laws and regulations of chemical services in the state of Florida, My establishment is licensed under Body Works Insurance.
If you clicked yes, please continue filling out the form and I will contact you shortly. If you have clicked no, you are also agreeing to release all prosecution and fines or any other legalities.
Patches are highly suggested, but I am very humble to know not everybody has the leniency of coming in 5-7 days before the appointment, and then coming in again for the service, I have made this form to give the consent to release if you choose to opt out of this. There is still the risk of reaction happening. Please be aware.

Waiver of liability

Care and maintenance

Medical conditions/Informed consent,

Did you add/want to on any other services?

If this was something you missed while booking but are still interested in adding, send me a quick email and I will fix this

Company Scheduling Policy’s

Our time is very valuable. To ensure that we can provide all of our clients with excellent service, we ask that you be on time to all of your appointments. Please arrive at least 5 to 10 minutes prior to your scheduled time to ensure you receive your full appointment time.

In the event that you should be tardy, we ask that you be considerate and call to inform us of your situation so we may take necessary action or make special arrangements but extra time will not be added to your appointment. Please be aware that if you are 15 minutes or more late to your appointment, you will be voided. You will need to reschedule. NO EXCEPTIONS.

In the event that you need to cancel or reschedule your appointment, we asked that you notify us at least 48 hours in advance of your scheduled appointment from your customer panel.

● WE RESERVE THE RIGHT: to invoice 50% of the scheduled service price when cancelling or rescheduling less than 48 hours prior to your appointment.

● WE RESERVE THE RIGHT: to invoice 100% of the scheduled service(s) on No-Shows.

** If you have a voucher please see fine print on voucher ** The satisfaction of our clients is our main priority. We offer prompt solutions to any problems or concerns that may occur.

We do not offer refunds, credits, we may offer exchanges for products sold or services rendered but this is only by a case by case promise.

If, for any reason, you feel dissatisfied with any of our services, please bring this to management’s attention. We appreciate all feedback, negative or positive, from our clients to better serve you. As part of our service we like to provide follow-ups by email (, for any questions or concerns.

I understand and acknowledge polishbyjess, LLC.’s policy regarding lateness and appointment cancellations.