I understand that my data will be strictly confidential. Faceville Aesthetics does not sell, share, or resell information. I confirm that all information in this form is true and accurate. I confirm that if I hold some important information and complications happened, the clinic will not be liable. I release this clinic and hold harmless against any claims, expenses, damages, and liabilities. I understand, have read, and truthfully completed this questionnaire. I agree that this is full disclosure and supersedes any previous verbal or written disclosures. I understand that withholding information or providing incorrect information may result in contraindications and/or skin irritation from treatments. I am aware that it is my responsibility to inform the esthetician/skin care therapist of any current medical or health conditions, as well as to keep this history up to date. The treatments I receive here are entirely voluntary, and I hereby release and accept full responsibility for this institution and/or skin care professional.