CARBON LASER CONSENT FORM
Thank you for Choosing EN Signature Brows and Beauty Studio for your services. We love to give our clients the best quality service. Please fill out the form below.
Name
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First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
Occupation
I understand that erythema (redness) and edema (swelling) are common immediate reactions from the Carbon Laser Facial treatment process. These typically resolve within 2 weeks, but can last longer. There is a possibility of rare side effects such as blisters, hyper pigmentation, hypo pigmentation, infection, or scarring may occur. I may alsofeel a warming sensation of the skin during treatment. This is a temporary condition and I understand that each person’s discomfort level may vary.
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I understand that 1-3 treatments are required for the CarbonLaserFacialto be most effective. I understand that it is important to follow the recommended maintenance schedule for future treatments to keepthe best possibleresults. I also realize that each individual's treatment response maybe different; therefore, the number of treatments may vary to achieve desired results.
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I understand sun exposure, tanning beds, sunless tanning lotions and tanning creams can cause discoloration or a reaction prior to or during the course of laser treatments. A broad spectrum (UVA/UVB) sun screen SPF30 or greater should be applied to the area(s) to be treated whenever exposed to the sun.
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Initial
Client's with opened wounds, malignant skin tumors and certain diseases, tattoos, or currently taking Accutane cannot be treated.
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Initial
I also understand that once I've started my treatment program there are no refunds.
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Yes, I agree
I understand and agree that All About Aesthetics may choose to take photos of my treatment area for the purpose of monitoring my progress.
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Yes, I agree
I am over 18 years of age or I have parental consent co-signed below.
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I am over 18.
I have parental co-sign
I give Elizaveta Neginskaya permission to take, publish and reproduce photographs of me, my face, and/or my eye area, both before and/or after the procedure for advertising and other purposes.
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Yes
No
I am 18 years or older.
Yes, I am 18 years or older
No, I am not 18 years old. I have a parental and/or guardian signature for consent below.
I am not 18 years old. I have a parental and/or guardians consent with a signature. By signing you understand all of the possible risks with this service.
Please print Parental and/or guardians name.
first and last name
I have read and understand this consent form and I agree to its terms and authorize treatment. I further understand that Elizaveta Neginskaya LLC can not guarantee the results and I will not hold Elizaveta Neginskaya LLC or their employees responsible for my individual results of the fractionated CO2 laser that I have requested.
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REFUND POLICY: Individual services, promotional services, sale services, series services, gift certificates purchased for yourself or for another individual are absolutely non-refundable.This applies to all of the procedures offered at the salon. There are NO REFUNDS on any procedures or services we have already initiated or already completed. NO EXCEPTIONS.
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Today's Date
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Month
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Day
Year
Date
Please provide an email for follow up care.
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example@example.com
Submit
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