I hereby consent to and authorize Eye Candi Spa to preform the following procedure(s).
I have voluntarily elected to undergo this treatment/procedure after the nature and purpose of this treatment has been explained to me, along with the risks and hazards involved, by Eye Candi Spa.
Although it is impossible to explain every potential risk and complication, I have been informed of possible beneifts, risk, and complications. I also recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require further treatments of the treated areas to obtain the expected results at an additional cost.
I have read and understand the post treatment homecare instructions. I understand how important it is to follow all intrustions given to me for post treatment care. In the event that I may have additional questions or concerns regaurding my treatment or suggested home product/post-treatment care, I will consult the estheticain immediately.
I have also, to the best of my knowledge, given an acurate account of my medical history, listing all known allergies inlcuding any allergie to benzocaine, lidocaine, tetracaine or prescription drugs. Any products I am currently ingesting or using topically. I am not pegnant or breast feeding and have not been prescribed Accutane in the last six months.
I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I do not hold Eye Candi Spa responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.