pence

Name*

DOB*

AGE*

Email*

example@example.com

Please read and initial each section below:*

I understand that Lulus Beauté Studio & Esthetics will perform a hydrodermabrasion treatment on my face, neck, decollete, or other area as determined between myself and my esthetician.The nature of this service and the potential risks involved have been explained to me, and I this treatment as suitable.I acknowledge and confirm that I have NOT had any tanning, waxing, microdermabrasion, laser hair removal, prescription topical products, acid-based oral or topical products, or any other exfoliating products that may be drying or irritating on the area to be treated.I understand that I should not tan, wax, exfoliate, avoid acids and retinols, or seek a cosmetic treatment for at least 2 weeks after receiving this treatment.I understand that I must wear spf 30+ with broad spectrum coverage to protect my skin during sun exposure but agree to limit sun exposure for 72 hours post treatment.I understand I must avoid excessive sweating and strenuous activities for at least 24 hours.I acknowledge and accept that I may experience some of the following side effects including but not limited to redness, irritation, and tightening.

By signing below, I understand that topical creams, medical conditions, and certain medications can affect the results of hydrodermabrasion. I understand that I can not have this treatment if I have certain contraindications and I hereby release Lulus Beauté Studio & Esthetics harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act, or misinformation both intentional or accidentally on this form as well as failure to follow post-care instructions after my service.

Signature*

Date*

Date

Personal Information