Facial Consent Form

Room 9 3/4 Facial Consent Form

The treatment you will receive is a clinical treatment designed to exfoliate or remove the outer layers of the skin. It is important that you strictly adhere to your home care products that your aesthetician has recommended. No guarantee is expressed or implied as to the precise results, peeling times or discomfort. Please carefully read the following statements. After you have read each statement, please initial each in the space provided.

I understand that the practice of medicine is not an exact science, and therefore results cannot be guaranteed. I acknowledge that no guarantee has been given to me as to the condition of my skin or degree of improvement expected following the treatment. *

I agree that there may be shedding or flaking of the skin and to not pick, peel, scratch the skin during the healing phase. *

I understand that there are potential risks and complications that may require further treatment. These include but are not limited to: Discomfort, changes in pigmentation, swelling of the area, scarring, infections, blistering, abrasions, inflammation, bruising, itchiness, and redness. *

I agree to follow all post care instructions and to notify Jenny immediately if any concerns arise. *

I hereby declare that I have read and fully understand the above consent. I have been fully informed regarding associated risks of the treatment. All of my questions have been answered in a satisfactory manner. *

Client Signature

Clear

Date

Witness if client is under the age of 18

Date