Consultation Form

Do you have any allergies?

Yes No

If yes please specify

Are you taking any prescription medication, both topically and internally?

Yes No

If yes please specify

How did you hear about us?

Any special instructions, comments or suggestions?

I confirm that all information indicated on this form is true and accurate.By signing below I agree to the terms and conditions of Aloula.

Date signed digitally

Social media consent for Photography/Image Use - Release Form

I give Aloula, and its proprieter Changel Goosen, the irrevocable right to take, hold and publish my image, by way of digital photograph.

I consent for that digital photograph to be used for advertising, marketing, general dispay and for use on social media platforms.

I waive any interest I may have in the copyright to my image, now or into the future.

I agree to make no claim against Aloula for any payments for the use of my image.

I agree to release and indemnify Aloula, and Chantel Goosen from any loss, expense, or claim connected with the publication of my image.

If the subject of the image is under the age of 18, a parent or guardian accepts the terms of this release on their behalf.

I agree to above mentioned (guardian)

I do not agree to above mentioned (guardian)

Date signed digitally