I understand and agree that all services rendered to me are charged to me directly and that I am personally responsible for payment.
I am not pregnant or trying to become pregnant nor am I nursing at this time.
The nature and purpose of the treatment have been explained to me. I have read and understand this agreement. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. Alternative methods of treatment and their risks and benefits have been explained to me and I understand that I have the right to refuse treatment.
I release Beauty Marx, all staff and providers from liability associated with the procedure. I certify that I am a competent adult of at least 18 years of age. This consent form is freely and voluntarily executed and shall be binding upon my spouse, relatives, legal representatives, heirs. administrators, successors and assigns.
Note: All prices are subject to change without prior notice.