Client Consent Form
I hereby consent to and authorize the Aesthetician or Registered Nurse to perform the following procedure:
*
Please Select
Micro-Channeling
Hydration Facial (Hydra)
Enzyme Facial (Relaxation Facial)
Oxygenation Facial (Face, Neck & Décolleté)
Injections (R.N)
Dermaplane
Chemical Peel
Miscellaneous
Client Name (printed):
*
First Name
Last Name
Client Name (signature) :
*
Date of Appointment:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of Signature:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Esthetician Signature:
Submit
Should be Empty: