CBD

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Client Information

Name

Date of Birth

Phone Number

Address

Service Information

Type of Service

Other

CBD Concentration

Health Considerations

Do you have any known allergies to CBD or other hemp-derived products?

Please specify

Are you currently taking any medications (prescription or over-thecounter)?

Please specify

Do you have any medical conditions (e.g., liver issues, heart conditions) that may affect your use of CBD?

Please specify

Are you pregnant or nursing?

Please specify

Have you consulted with a healthcare professional regarding the use of CBD products?

Consent Statement

I, the undersigned, understand and agree to the following:

Use of CBD Products

I acknowledge that I am receiving a massage or esthetician service that involves the use of a CBD product containing less than 0.3% THC.

Potential Effects

I understand that the effects of CBD may vary from person to person, and I will communicate any discomfort or adverse reactions during the treatment.

Health Risks

I acknowledge that I have disclosed all relevant health information and that withholding information may increase the risk of adverse reactions.

Not a Substitute for Medical Treatment:

I understand that CBD products are not a substitute for professional medical advice, diagnosis, or treatment and that I should consult my healthcare provider for any medical concerns.

Consultation Opportunity

I have had the opportunity to ask questions about the product, its use, and any potential risks associated with my treatment.

Liability Waiver

I release the service provider from any liability associated with the use of CBD products during my treatment and agree to use them at my own risk.

Results May Vary

I understand that individual results from the use of CBD products may vary and are not guaranteed.

Client Signature

Client Date

Parent/Guardian Signature (if applicable)

Parent/Guardian Date

CBD

CBD

Client Information

Service Information

Health Considerations

Consent Statement

Contact Us

Payments Accepted