Acknowledgement and Waiver I hereby agree to have this treatment.  I am aware that even with natural ingredients there is a remote chance of an allergic reaction and there is a possibility of an adverse reaction to product used in facials. Please inform your esthetican before treatment if severly allergic, as this may make you unable to receive the service.  I am also aware that certain services should not be performed with certain medical conditions or prescriptions. I have disclosed all my known medical conditions, skin conditions, allergies, medications and answered all questions honestly on the above form and agree to update Bloom a Skincare Studio as to any changes. It is my responsibility to disclose all medical, medicinal, and skin history, as Bloom a Skincare Studio will not be responsible to reactions caused by undisclosed medical history. I acknowledge the esthetician at Bloom a Skincare Studio does not provide medical advice and I accept full responsibility to seek out advice before receiving any services or products from Bloom a Skincare Studio. I hereby release, discharge and waive all claims against Bloom a Skincare Studio, and representatives or any person(s) performing services or applying any products at Bloom a Skincare Studio, including from liability and responsibility for any and all illness, injuries, damages, claims, rights and causes of action of any kind or nature, that may occur during or arising out of any services or products received on this and any future dates. I expressly assume and accept the risk for any injuries sustained. I have read this entire document and agree to its terms. This consent includes all facial treatments/services included on the booking site provided by Bloom a Skincare Studio with no expiration date end.

Tretinoin must be used in the prescribed fashion according to the written instructions and descriptions given to me. I understand that I will experience varying degrees of the following symptoms:
Dryness - Redness - Exfoliation/Peeling - Itching - Sensitive Skin - Burning - Wrinkles May Look Worse - Acne May Look Worse

These symptoms will lessen and eventually subside as my skin builds tolerance.
I agree to continue with the use of Tretinoin and to return for follow-ups as directed. Doing so will help with my safety and provide adjustments towards maximizing results.

I understand the best results are achieved with adherence to the program over several weeks and/or months.

I understand that excessive application of the products or picking, rubbing the skin can cause a great deal of discomfort and even blistering, especially in the early weeks of treatment. If any reactions are initiated to the point of skin breakdown or infection, I will contact the office immediately. Careless inattention to such reactions may result in complications such as infection, injury, discoloration, or possible superficial scarring.

I understand that it is necessary to maintain the use of my prescribed protocol throughout the treatment period. This is necessary to retain the benefits during the program.

No studies have been conducted in humans to establish the safety of Tretinoin in pregnant women. If you are pregnant, think you’re pregnant, or are nursing a baby, consult your physician before using the medication. It is not recommended that you use Tretinoin if you are pregnant, think you are pregnant, or are nursing an infant.

I understand a sunscreen of at least SPF 35 is to be used on a daily basis, and to practice sun safe guidelines when outdoors.

I understand that I must adhere to the guidelines prescribed.

I have read and fully understand the above, received satisfactory answers to my questions and had a chance to discuss alternative treatments.