Esthetician Consent Form

Client Name*

First NameLast Name

Date of birth*

Date

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

LED Light Therapy Release

• Wear protective eyewear. Failure to wear protective eyewear may result in severe bums or long- term injury to injuries to the eyes.
• Medications or cosmetics may increase your sensitivity to the red and/or LED light. Consult a physician before using red light therapy or LED light therapy if you are pregnant, using medications or have a history of skin problems.

• For best results it is highly recommended you use products specifically made for red light/LED light therapy.
• I understand that the more and longer period of time I use red light/LED light therapy, the better results I will receive.

• I understand that the use of red light/LED light therapy not intended to diagnose, treat, cure or prevent any disease.
• I verify with my signature that I am at least 14 years of age and, if under 18 years of age I have been given permission to use red light/LED light from my parent or legal guardian.

To my knowledge, I have no medical condition or allergy that would prohibit me from using red light/LED light therapy. I acknowledge that the results of red light/LED light therapy do vary, and that no guarantees of specific results are offered or implied. SKIN by CARIN will not refund or credit any amount of money because of a client’s unhappiness with their final results. I have been given adequate instructions for the proper use of the equipment, understand the risks involved, and use it at my own risk. I hereby agree to release the owners, operators and manufacturers from any damages that I might incur due to the use of this facility. I have reviewed and completely understand all of the information at SKIN by CARIN, including this form.

As Parent/Legal Guardian of the above listed Client, I acknowledge that I have read and understood the safety standards and warnings provided to me by SKIN by CARIN and thereby authorize the consumer named above to use red light/LED light therapy. I acknowledge that I have read and completely understand this consent form, and agree to the above waivers of liability, recommendations and terms. I attest that I have provided accurate age, identity and relationship verification.

LED Light Therapy Release Form*

I have reviewed and completely understand all of the information at SKIN by CARIN, including this LED Light Therapy Release form.

I understand this entire consent form and medical history form, and have answered each question truthfully. I understand that withholding information from my esthetician may result in contraindications or skin irritation from treatments received.

I understand that there is a 24-hour cancellation policy and if cancelled within 24 hours/no show to the appointment will result in a cancellation fee. The skin care treatments I receive at SKIN by CARIN are voluntary and I release SKIN by CARIN from liability and assume full responsibility thereof.

Client Signature*

Date*

Date