Please Take A Moment To Carefully Read All Information.

A facial treatment may consist of cleansing, enzyme exfoliation, hydro-dermabrasion, LED light therapy, mild chemical peels, manual extractions, serums or steam. Treatments take approximately 45 to 75 minutes to complete and are designed for your skin type and concerns.

Implements and equipment used in this studio are disposable or properly sterilized according to the State Board of Cosmetology regulations.

I have not been exposed to any recent radioactive or chemotherapy treatments, sunburns, windburns, or broken skin and my skin does not feel sensitive or irritated in any way. I have not had any other chemical peel of any kind, within 14 days of this treatment. I have not had any facial waxing, within seven days of this treatment. I have informed the clinic of all health problems of which I am aware, including herpes simplex/cold sores.

I have informed the clinic of any use of oral or topical medications I may be using including; Retinoids (Retin-A, Renova, Avita, Differin, Tazorac) or Accutane. I am over the age of 18 years. If below 18 years of age a parent or guardian must also sign this form.

IMPORTANT: Please Read & Initial

I understand that controlling acne/problem skin is best achieved through a series of recommended treatments and compliance to the home care product program recommended by my skin therapist. I understand that I will probably not experience much visible peeling, flaking, discoloration or irritation following this procedure if I follow my home care instructions carefully. I understand and agree to follow the home-care instructions and recommendations provided by my skin therapist. I understand that I will be responsible for following home regimens that can minimize or eliminate possible negative reactions, including recognizing the importance of adhering to a sunscreen, avoiding the sun/tanning booths, avoiding extreme weather conditions, avoiding excessive exercise, and using a moisturizer specifically recommended to me by my skin therapist. I realize and accept that the consequences of failure to adhere to these instructions may yield undesirable results. I understand all services and products are non refundable. I understand there are certain contraindications that would preclude me from receiving LED treatments, including; epilepsy, medications causing light sensitivity, open wounds, pregnancy, and thyroid conditions.

I consent to "before and after" photographs and videos taken of my face to be used for purpose of documentation, monitoring treatment progress, potential advertising, and promotional purposes.

Rescheduling Guidelines & Late Policy

A 24-hour rescheduling notice is required. We realize emergencies happen and will be considered, but reserve the right to charge 50% fee of service for missed appointments without a 24-hour notice. If you are more than 10 minutes late we cannot guarantee that we will be able to fit your appointment into the schedule and you may not be seen. If we cannot fit you in there will be a 50% fee of service charged for the missed appointment to the card on file.

This agreement will remain in effect for this procedure and all future procedures conducted by my technician. I understand that this agreement is binding and I have read and fully understand all information above and have had sufficient opportunity for discussion to have any questions answered. I have accurately answered the questions above, including; all known allergies, medications, or products I am currently ingesting or using topically. I understand the procedure and accept the risks. I do not hold the technician, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.