1. I voluntarily request that Source Skin Care, LLC and its practitioners may perform a customized (dermaplane)/microdermabrasion facial, Glo2Facial or facial waxing. I acknowledge having been informed that this cosmetic procedure is intended to exfoliate and improve skin texture/appearance or to remove unwanted hair. 2. I understand that my skincare professional can discover other, or different conditions that may require additional or different procedures than those planned. If my skincare professional discovers such other or different conditions, I will be referred to the appropriate medical care provider. 3. I also realize that the following risks and hazards may occur in connection with the particular procedure; worsening or unsatisfactory appearance, redness, swelling, scarring, or recurrence of the original condition. 4. If this procedure creates UV sensitivity, I understand I must use sunscreen of SPF 30 or greater at all times throughout the course of treatment. 5. I acknowledge my obligation to follow the written and/or spoken instructions covering my pre and post treatment skincare regimen. 6. I understand that multiple treatments may be required for some services. If so, the cost of these services was disclosed prior to receiving. 

I certify that I have read the above consent and I fully understand it. I have been given ample opportunity for discussion and all my questions have been answered to my satisfaction. I hereby consent to the procedure. This constitutes the full disclosure and supersedes any previous verbal or written disclosures.