Fashion Theatre and Media Make-Up Sample Client Consultation Form

Download Fashion Theatre and Media Make-Up Sample Client Consultation Form

Post on 08-Apr-2015

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Client Consultation Form Fashion, Theatre & Media Make-upCollege Name: College Number: Student Name: Student Number: Date: Client Name: Address: Profession: Tel. No: Day Eve 4050 5060 60+PERSONAL DETAILS Age group: Under 20 2030 3040 Lifestyle: Active Sedentary Last visit to the doctor: GP Address: No. of children (if applicable): Date of last period (if applicable): CONTRAINDICATIONS REQUIRING MEDICAL PERMISSION in circumstances where medical permission cannot be obtained clients must give their informed consent in writing prior to treatment. (select if/where appropriate): Any skin condition being treated by a Inflamed nerve dermatologist Bells Palsy Nervous/Psychotic conditions Skin cancer Recent facial operations Undiagnosed pain in the face CONTRAINDICTIONS THAT RESTRICT TREATMENT (select if/where appropriate): Fever Hypersensitive skin Contagious or infectious diseases Conjunctivitis Under the influence of recreational drugs or Any eye surgery (approximately 6 months) alcohol Stye Any known allergies Watery eye Infectious skin diseases and disorders Contact lenses must be removed Undiagnosed lumps and bumps Very nervous clients Localised swelling Blepharitis Inflammation Eczema Cuts Psoriasis Bruises Dermatitis Abrasions Sycosis barbae Scar tissues (2 years for major operation and 6 Pediculosis capitis months for a small scar) Herpes simplex Sunburn Seborrhoeic Dermatitis Recent fractures (minimum 3 months) Alopecia Sinusitis Bells palsy Neuralgia Temporo-mandibular joint tension (TMJ Sunburn Syndrome) Migraine/Headache SKIN TEST (select if/where appropriate): Moisture content: Excellent Good Fair Poor Muscle tone: Excellent Good Fair Poor Elasticity: Excellent Good Fair Poor Sensitivity: High Medium Low Skins healing ability: Excellent Good Fair Poor Skin tone: Fair Medium Dark Olive Circulation: Good Normal Poor Pores: Fine Dilated Comodones MiliaOVERALL SKIN TYPE/CHARACTERISTICS (select if/where appropriate): White Black Asian skin type Mixed Dry Oily Combination Brief Description: MatureYoungCHARACTERS TO INCLUDE (select where appropriate): High fashion look Oriental make-up Ballet/dance make-up Period make-up Pantomime Fairytale An animal Crepe hair Fantasy make-up Beard Character using prosthetics Moustache Character with bruises and scars Stubble 4 special effects: 1 2 3 4 Research materials:Clear explanation and instructions of how to create the character:Photographs to show progressive shotsReflective practice:Overall Conclusion:Client Signature................................................................. Student /make-up artist signature......................................

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