Acne Treatment Consent Form

An acne treatment may consist of surface cleansing, mild chemical peels or steam and exfoliation, application of antibacterial serums, corrective serums and extractions. Treatments take approximately 20 minutes to 1 hour to complete and are designed to balance, hydrate, clear acne impactions and prepare the skin for the home care regimen. Implements and equipment used in all this facility are disposable or properly sterilized according to the State Board of Cosmetology regulations.

IMPORTANT: PLEASE READ CAREFULLY AND INITIAL

WARNINGS: PLEASE READ CAREFULLY and initial

Avoid direct sunlight or tanning booths for at least three days following a treatment. Use of sunblock protection is necessary following all treatments. Do not pick your skin following a treatment. Face Reality Skin Care products are clinical-strength active formulas designed to treat problem skin conditions. Tingling sensations are normal with product application but should not be painful. If you are experiencing stinging and irritation with any product, stop using the product and call your esthetician for further instruction.

Avoid direct sunlight or tanning booths for at least three days following a treatment.

Use of sunblock protection is necessary following all treatments.

Do not pick your skin following a treatment.

Face Reality Skin Care products are clinical strength active formulas designed to treat problem skin conditions. sensations are normal with product application but should not be painful. If you are experiencing stinging irritation with any product, stop using the product and call your esthetician for further instruction.

RESCHEDULING GUIDELINES AND LATE POLICY: PLEASE READ CAREFULLY and initial

A 24-hour rescheduling notice is required. We realize emergencies happen and will be considered, but reserve the right to charge a $50.00 fee for missed appointments without a 24-hour notice. If you are more than 20 minutes late we cannot guarantee that we will be able to fit your appointment into the schedule and you may not be seen. If we cannot fit you in there will be a $50 fee charged for the missed appointment.

RESCHEDULING GUIDELINES AND LATE POLICY: PLEASE READ CAREFULLY and initial A 24 hour rescheduling notice is required. We realize emergencies happen and will be considered, but reserve right to charge a $50.00 fee for missed appointments without a 24 hour notice. If you are more than 20 minutes we cannot guarantee that we will be able to fit your appointment into the schedule and you may not be seen. If cannot fit you in there will be a $50 fee charged for the missed appointment.

monitoring treatment progress.

,consent to photographs taken of my face to be used for

I hereby agree to all of the above and agree to have this treatment be performed on me. I further agree to follow all post-treatment care instructions as I am directed.

Name

Date

Address

Street Address Line 2

CityState

Zip

Signature of Client

Signature of Esthetician