• I understand that my facial treatment may include clinical strength products, enzymes, acid pills, dermabrasion, derma planing, extractions, microcurrent, galvanic, high frequency, ultrasonic. LED Light Therapy and other treatment modalities as necessary. 

• I understand that this is a cosmetic treatment and that no medical claims are expressed or implied. I understand that to achieve maximum results, I may need more than one treatment and I need to follow the maintenance home protocol.

• I understand that there are no guarantees as to the result of this treatment, due to many variables such as age, condition of the skin, sun damage, smoking and climate. I may or may not experience actual peeling with this "procedure" as each case is individual.

• I understand that there may be some degree of discomfort, i.e stinging, "pin-pricking" sensation, hotness, or tightness. 

• I understand that although complications are very rare, sometimes they may occur in that prompt treatment is necessary. In the event of any complications, I will immediately contact my service provider.

• I agree to refrain from tanning or excessive sun exposure while I am undergoing treatment in 14 days after my treatment. I understand the direct sun exposure is prohibited while I am undergoing treatment and that the use of sunblock protection with a minimum SPF 30 is mandatory.

• I will review any medical conditions that may affect the treatment such as pregnancy cold sore tendencies, allergies, recent facial peels, laser or surgery, any types of contraindications medication such as accutane , hormone replacement therapy,steroidal medication or use of Retin-A. Contraindications medication should be discontinue five days prior to the treatment with exception of accutane which must be discontinue for six months prior.

• I have not had a peel treatment of any kind within 14 days of my treatment, from my service provider or any other service providers. I understand I cannot have another treatment until recommended by my service provider. I understand my responsibility of properly fulfilling the appropriate aftercare instructions as explained by my service provider. 

•PHOTOGRAPHS: I give permission for photographs to be used by my service provider and his/her staff for monitoring my treatment progress.

•Prior to receiving treatment, I have been candid in revealing any condition that may have an effect on this procedure as outlined. I will also inform my service provider of any changes in my medical history, current medication and/or any changes relevant to this procedure prior to any future treatments.

• I have read the contents of this consent form carefully and I fully understand it. I have been given the opportunity for discussion pertaining to the treatment and all my questions have been answered to my satisfaction. I hear by release my service provider, whise signature is below, in any of his/her stuff against any and all liability associated with this procedure. I have been adequately informed of the risk and benefits of this treatment and wish to proceed with a treatment.

• With my signature below, I give consent to receive treatments to my service provider and have read and completed the questionnaire truthfully. I understand I will be receiving a professional service from a licensed service provider. I further understand that the service provider neither diagnoses illness, disease or any other medical, physical or mental disorder. I am responsible for consulting a qualified physician for any ailment that I have. Because the service provider must be aware of any existing physical conditions that I have, I have listed all my new medical conditions and physical limitations and I will inform the specialist in writing of any change in my physical health. I agree that this constitutes full disclosure. I understand that withholding information or providing miss information may result in contradictions and/or irritation to the skin from treatment received. If any information changes between my appointments, I will let my service provider know. I understand there shall be no liability on the service provider for any services rendered.