Client Consent Form
I hereby consent to and authorize Armida Miranda, Esthetician to perform the following procedure:
*
Please Select
Micro-Channeling
Hydration Facial (Hydra)
Enzyme Facial (Relaxation Facial)
Oxygenation Facial (Face, Neck & Décolleté)
Dermaplane
Chemical Peel
Miscellaneous
Client Name (printed):
*
First Name
Last Name
Client Name (signature) :
*
Date of Appointment:
*
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Month
-
Day
Year
Date
Date of Signature:
*
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Month
-
Day
Year
Date
Esthetician Signature:
Submit
Should be Empty: