Buccal Consent

Name

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Address

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Age

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Have you been tested positive for covid in the past 72 hours ?

Have you been diagnosed with any sexually transmitted disease?

If yes, are you experiencing any breakout?

Buccal massage is the most advanced form of facial massage technique developed in Paris. This massage is unique in that it details working on not only on the outside of the face but on the inside through oral cavity. This allows me to reach deeper layers of muscle tissue resulting in a natural face lift effect without surgical invasion.

There are contraindication for this facial please read carefully and choose all that apply to you.

In order to achieve positive results a course of several treatments is recommend. The exact amount of treatments will be determined at your first appointment. To preserve the results of treatment, buccal should be done a few times a year after your assessed amount of treatments, along with using products recommended by the esthetician.

By signing below, you agree to the following:

• I give permission to receive massage therapy

•I understand that buccal massage is not a substitute for medical treatment or medication

•I understand that the esthetician does not diagnose illness, injuries, or prescribe medications

•I have clearance from my physician to receive massage therapy

•I understand the risk associated with buccal massage may include: short term muscle soreness, superficial bruising, exacerbation of undiscovered injury, raw kind of feeling in mouth after buccal massage.

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