Acne Program Client Agreement Form
Please initial and check each box
Name
First Name
Last Name
Each time we strengthen your home care, we run the risk of drying and irritating your skin, so you need to communicate that to us if that happens
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We must adjust your home care routine every two weeks to keep your progress to clear skin forward. If we don't change how you do your home care often enough, your skin will adapt to the and stop responding (in other words, you won't get clear).
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The Regimen.
I will not use any other products that have not been approved by my skincare professional whileI
I will not change the regimen given to me by my skincare professional without notifying or
Iwill not run out of product while working with my skincare professional. When you stop using
I will not have other skin care treatments while I am being treated by my skincare professional.
I will inform my skincare professional of any medications/drugs that I start taking while using thei r products (or run out) acne will start forming inside the pores and you will see it about a month later.
. I AGREE TO CONTACT MY SKINCARE PROFESSIONAL IF MY SKIN UNCOMFORTABLY DRY AND IRRITATED.
I AGREE TO CONTACT MY SKINCARE PROFESSIONAL SO WE CAN ADJUST YOUR HOME CARE REGIMEN AT LEAST EVERY TWO WEEKS
Sunscreen will help to keep your skin moisturized. Without it, your skin will get too dry.
I will use my sunscreen every morning, regardless of whether or not I will be going outside. The
I will not get sunburned or wind burned while being treated by my skincare professional. You will not be able to use your active products; and we will not be able to do treatments on you
Health&lifestyle
I will inform my skincare professional if I elect to do any laser treatments or waxing for hair removal at any time
(For women) - I will inform my skincare professional if I get pregnant or are having troubles with hormones.
I will inform my esthetician If i have any facial cuts, sores, stiches or possible infection.( If so, treatments will be put on hold until issues have resolved)
Any sports, lifestyle changes, added medications, i will notify my esthetician.
MOST IMPORTANTLY: IF WE ARE UNABLE TO IMPROVE THE CONDITION OF YOUR SKIN DUE TO FACTORS BEYOND CONTROL, BUT WITHIN YOURS, WE RESERVE THE RIGHT TO DECLINE TREATMENTS. (THAT IS, IF YOU ARE NOT FOLLOWING INSTRUCTIONS PERTAINING TO HOME CARE, DOING YOUR HOME CARE, LIFESTYLE ISSUES, ETC.)
If you have initailed all points than you are one step closer to clear skin with " Carly Larson esthetics Acne program" . please sign below to validate initails
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