• skStacy Kaine Intake Form

  • 539 east walnut ave, Unit A El segundo, Ca, 90245 (818) 636-7378

    Are you currently under the care of a physician?

    Have you ever experienced claustrophobia

    Are you pregnant or breast-feeding?

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  • I acknowledge that my skin might experience temporary irritation, tightness, redness or slight swelling which usually dissipates within 72 hours depending on skin sensitivity.

    I acknowledge that if I am allergic to one or more ingredients in the products used, I may experience allergic reactions.

    I acknowledge that if I fail to use a minimal sunscreen (SPF45), I am more susceptible to sunburn, skin damage & hyperpigmentation. I should avoid excessive sun exposure especially between 10am-2pm.

    I acknowledge that this treatment is a strictly elective cosmetic procedure and no medical claims have been expressed or implied.

    I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, waxing, and products containing acids that are no part of the recommended take-home regimen for 2-4 weeks following treatment. I release Stacy Kaine and its staff of any liability associated with any injuries and/or current and future conditions resulting from the skincare procedures or products. Signaturewed

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