Confidential Client Health History Update

No Changes to My Health History Ihave confirmed that there have been no changes to my health history and I have not started any new medica- tions since my last visit. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contra- indications and/or irritation to the skin from treatments received. I am aware that it is my responsibility to inform my skin care therapist of my current medical or health conditions and to update this history. The treatmentsI receive here are voluntary and I release this institution and/or skin care professional from liability and assume full responsibility thereof.

New Health History Information/Update Ihave confirmed that there have been changes to my health history since my last visit and have made note of those changes below. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contra- indications and/or irritation to the skin from treatments received. I am aware that it is my responsibility to inform my skin care therapist of my current medical or health conditions and to update this history. The treatmentsI receive here are voluntary and I release this institution and/or skin care professional from liability and assume full responsibility thereof.

Associated Skin Care Professionals