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FACIAL CONSENT FORM

FACIAL CONSENT FORM

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    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
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    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
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  • 21
    Suggestion: Hair must be mostly untangled to avoid breakage and feeling uncomfortable
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  • 24
    • The Client understands that the number of Microneedling and Chemical Peel treatments required varies and that several treatments may be needed.
    • The Client understands that there may be some degree of discomfort, (i.e., scratchiness, itchiness, irritation, stinging and hotness.)
    • The Client understands that it is normal for the treated area to appear red with slight swelling after the treatment, similar to mild-moderate sunburn, which can last for up to 4 days following treatment. There may also be very mild temporary bruising.
    • The Client understands that this procedure does not come with any guarantees and understands in order to achieve maximum results, they will need maintenance treatments and the use of daily recommended products.
    • The Client understands that exposure of a recently treated area to direct sunlight should be avoided and that we advise the use of an SPF of 30 or higher.
    • The Client confirms that they have informed BellaBrow by Vera Esthetics of all their medical details relevant to this treatment and will inform BellaBrow by Vera Esthetics of any changes throughout the duration of the treatments should any information change.
    • The Client confirms that they have understood all the information given regarding this treatment during the consultation and that any questions that have been presented have been answered satisfactorily.
    • The Client understands that there are other treatment options available, including doing no treatment at all.
    • The Client acknowledges that they have read and fully understood this document before signing.
    • The Client releases BellaBrow by Vera Esthetics of any and all liability.
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    • I acknowledge that I must adhere to BellaBrow by Vera Esthetics' policies.
    • I understand that deposits are non refundable.
    • I understand that in order for my deposit to be transferable, I must give a 2 week notice.
    • I understand that after 15 minutes of tardiness my appointment may be subject to cancellation and I will be responsible in accordance with the “No-show” policy.
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    • I acknowledge that my skin might experience temporary irritation, tightness, redness or slight swelling which usually dissipates within 72 hours depending on skin sensitivity. 
    • I acknowledge that if I am allergic to one or more ingredients in the products used, I may experience allergic reactions.
    • I acknowledge that if I fail to use a minimal sunscreen (SPF 30), I am more susceptible to sunburn, skin damage & hyperpigmentation.
    • I should avoid excessive sun exposure especially between 10am-2pm.
    • I acknowledge that this treatment is strictly elective cosmetic procedure and no medical claims have been expressed or implied.
    • I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, waxing, and products containing acids that are no part of the recommended take-home regimen for 2-4 weeks following treatment.
    • I consent (to the best of my knowledge) that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment.
    • I give consent for all future treatments.
    • I release BellaBrow by Vera Esthetics LLC and its staff of any liability associated with any injuries and /or current and future conditions resulting from the skincare procedures or products.
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    By signing the next screen I am agreeing to all policies mentioned above:

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