Microneedling Consent Form
  • Microneedling Consent Form

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  • Photo/Video Release

    As a small business, I utilize social media to promote my services. I don't want to do anything that makes you uncomfortable so I ask that you complete the following questions to let me know if i have your permission to use photos or videos, and whether or not you'd like to be identified. Thank you in advance.
  • I hereby authorize Pure Esthetics/Cindy Brazinski to use my photos and videos. I understand this may include social media, advertisement, promotional material, and/or other similar ways. My consent is freely given without expecting payment.*
  • I release Pure Esthetics/Cindy Brazinski from any and all liability that may arise from the use of my photos/videos.*
  • I prefer that:*
  • Should be Empty: