Please list your emergency contact NAME*andPHONE NUMBER*
Your occupation: blanks*
Who referred you? blanks*
I blanks*, do fully understand all of the questions above and have answered them all correctly and honestly. I understand that the services offered are not a substitute for medical care. I understand that the skin care professional will completely inform me of what to expect in the course of treatment and will recommend adjustments to my regiment if deemed necessary. I am also aware that individual results are dependent on my age, skin condition, and lifestyle. I agree to actively participate in following appointment schedules and home care procedures to the best of my abilities so that I may obtain maximum effectiveness. In the event that I may have additional questions or concerns regarding my treatment or suggested home product routine, I will inform my skin care professional immediately. I release and hold harmless the skin care professionals, Helium Salon, and the staff from any liability for adverse reaction that may result from this treatment.