Tanning intake form Name * First Name Last Name Email * Phone * Date of birth * Tanning History Have you ever had a spray tan or used self tanning products before? Yes No Have you ever had any skin reactions from spray tanning or using self tanning products? Yes No If yes, please explain. Are you allergic to Dihydroxyacetone (DHA)? Yes No Do you suffer from any other allergies? Yes No If yes, please explain. Do you suffer with any respiratory problems? Yes No Do you suffer from any skin conditions? Yes No If yes, please explain. Skin Description Skin Type Dry Sensitive Combination Acne Prone Oily Skin Tone Warm Neutral Cool How often do you moisturize? Every day Sometimes Never Did you exfoliate before your visit? Yes No How well do you tan in the sun? Always burn, but never tan Burn, but you can still achieve a tan Tan easily, but rarely burn Release (Fill in name below) I ,_______________________, in consideration of the services provided, hereby release GLO XO, its distributors and or dealers from all manner of actions, cause of action, which may arise from the use of any products, services or services provided. * Thank you!
