FACIAL CONSENT FORM

  • FACIAL CONSENT FORM

  • Date
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  • The following may be contraindicated to your service, please acknowledge if the following may pertain to you:

  • Are you prone to herpes, cold sores or have any open sores and lesions?
  • Do you have any irregular pigmented warts, growths, or pigmented scars or tend to bruise easily?
  • Are you being treated for any cancers or autoimmune diseases such as HIV, lupus, hepatitis, diabetes?
  • Do you have a history of epilepsy or seizures or have any metal implants or pacemakers?
  • Have you recently had Botox, filler injections, laser, chemical peels, or microdermabrasion procedures?
  • Are you currently pregnant and/or Breastfeeding?
  • Are you taking Accutane/Retin-A/or other medications prescribed by a doctor for acne/wrinkle prevention?
  • Do you have any allergies or have sensitivity to certain products?
  • Are you currently taking aspirin/Ibuprofen, birth control, antibiotics or any other prescribed medication?

  • SPA SERVICE AGREEMENT AND RELEASE OF LIABILITY FOR FACIALS

  •  Because spa services should not be performed under certain medical conditions, you affirm that you have stated all your known medical conditions honestly. You agree to keep your Esthetician updated as to any changes of your skin or medical profile and understand that there shall be no liability on the Esthetician's part should you fail to do so. After your service, your skin may experience tightness, dryness, redness, peeling, breakouts and/or hyper pigmentation or scaring. Following more intense treatments you may experience slight swelling and/or blood spotting. Healing may take 24 hours to several days. Please be aware that anytime the skin is broken there is slight risk of bacterial and viral infection. You must keep the treatment area clean and dry for up to one week following your treatment. Moisturize and protect the newly exposed skin with adequate sunscreen (SPF 30 or higher), as you are more susceptible to sunburn and skin damage.

    YOU UNDERSTAND AND VOLUNTARILY ACCEPT ANY RISKS ASSOCIATED WITH THIS SPA SERVICES OR ANY USE OF BELLE'S BEAUTY SKINCARE. THEY WILL NOT BE LIABLE FOR ANY INJURY OR DAMAGE TO YOU OR OTHERS RESULTING FROM NEGLIGENCE OF BELLE'S BEAUTY SKINCARE OR ANYONE ACTING ON BEHALF OF BELLE'S BEAUTY.

    By signing below, I acknowledge that I have read and understood the foregoing consent and agree to the treatments associated risks. I hereby agree to have this service performed and agree to follow all of the pre and post-treatment

  • My Products

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                    Basic Facial

                    Double Cleanse, Exfoliation, Facial Massage, Extractions, Customized Mask, Toner,Moisturizer, SPF

                    $60.00$60.00
                      
                    Hydrating Facial

                    Double Cleanse, Exfoliation, Facial Massage, Extractions, Hydrating Mask, Toner, serums Hydrating Moisturizer, Facial oils, SPF, Eye Serums, Lip Hydration

                    $70.00$70.00
                      
                    Deep Cleansing Facial

                    Double Cleanse, Exfoliation, Facial Massage, Extra Time For Extractions, Ultrasonic Skin Scrubber, Customized Mask, Toner,Moisturizer, SPF

                    $80.00$80.00
                      
                    Signature Caviar Collagen Facial

                    Double Cleanse, Exfoliation, longer Facial Massage, Extractions, Caviar Collagen Mask, Anti Aging LED Light, Toner, Caviar Collagen Serum, Moisturizer, SPF Eye Cream, lip Hydration

                    $90.00$90.00
                      
                    Microdermabrasion

                    Double Cleanse, Microderm Machine, Facial Massage, Extractions, Customized Mask, Toner, Serums, Moisturizer, SPF, Facial oils, Eye Cream, Lip Hydration

                    $100.00$100.00
                      
                    Microneedleing

                    Double Cleanse, Exfoliation, Facial Massage, Extractions, Serums, Microneedleing machine, Customized Mask, Toner, Serums, Moisturizer, SPF, Facial oils, Eye Cream, Lip hydration

                    $100.00$100.00
                      
                    Radio Frequency Facial

                    Double Cleanse, Radio Frequency Machine, Customized Mask, Toner, Moisturizer, SPF, Eye Cream, Lip Hydration

                    $100.00$100.00
                      
                    Deposit

                    You can pay in full by clicking the facial options or just leave a $25 Deposit. Deposit is mandatory if service is not paid in full. 

                    $25.00$25.00
                      
                    Total
                    $0.00$0.00

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