Treatment Evidence Form
Unit 845 – Provide Self Tanning
College Name:
College Number:
Learner Name:
Learner 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
30–40
40–50
50–60
Eve
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):
Epilepsy
Asthma
Cardio vascular conditions (thrombosis, phlebitis,
Any condition already being treated by a GP or
hypertension, hypotension, heart conditions)
dermatologist
Recent scar tissue
Medical oedema
Diabetes
Nervous/Psychotic conditions
Bell’s Palsy
Inflamed nerve
Trapped/Pinched nerve
CONTRAINDICATIONS THAT RESTRICT TREATMENT (select if/where appropriate):
Fever
Skin diseases
Contagious or infectious diseases
Vitiligo
Under the influence of recreational drugs or
Albinism
alcohol
Hypersensitive skins
Diarrhoea and vomiting
Highly vascular skins
Skin cancer
Undiagnosed lumps and bumps
Photosensitive skins
Pregnancy (sun beds only)
Urticaria
Cuts
Medication which causes the skin to become
Bruises
photosensitive, e.g. antibiotics, some blood pressure Abrasions
medication, tranquillisers
Scar tissue (2 years for major operation and 6 months
After any form of heat treatment
for a small scar)
After waxing
Sunburn
After electrolysis
Areas of undiagnosed pain
Excessive moles (more than 100)
Any metal pins or plates
Contact lenses (unless removed)
Loss of skin sensation
Epilepsy
After a heavy meal (sun beds only)
Recent operations
Recent X-ray (3 months)
Acute rheumatism
Botox/dermal fillers (1 week following treatment)
WRITTEN PERMISSION REQUIRED BY:
GP/Specialist
Informed consent
Either of which should be attached to the consultation form
Level 3 Unit 845 – Provide Self Tanning Treatment Evidence Form
PATCH TEST:
Self tanning:
Yes
No
TREATMENT: (select if/where appropriate)
Spray gun
Compressor
Buffing mitt
PRODUCTS: (select if/where appropriate)
Tanning cream
Tanning gels
Spray tan liquid
Barrier cream
Exfoliators
Moisturisers
Treatment details:
Client feedback:
After/Home care advice given:
Client Signature………………………………………………………….…
Learner Signature………………………………………………………….
Level 3 Unit 845 – Provide Self Tanning Treatment Evidence Form