Client Consultation Form – Fashion, Theatre & Media Make-up
College Name:
College Number:
Student Name:
Student Number:
Date:
PERSONAL DETAILS
Age group: Under 20
20–30
Lifestyle: Active
Sedentary
Last visit to the doctor:
GP Address:
No. of children (if applicable):
Date of last period (if applicable):
Client Name:
Address:
Profession:
Tel. No: Day
Eve
30–40
40–50
50–60
60+
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
Milia
OVERALL SKIN TYPE/CHARACTERISTICS (select if/where appropriate):
White
Black
Asian skin type
Mixed
Dry
Oily
Combination
Brief Description:
CHARACTERS 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 shots
Mature
Young
Reflective practice:
Overall Conclusion:
Client Signature.................................................................
Student /make-up artist signature......................................