I hereby consent to and authorize Love Peace Skin Aesthetics to perform skin care treatments, hair removal or glamour services.
I have voluntarily elected to undergo this treatment/procedure after the nature and purpose of this treatment has been explained to me, along with the risks and hazards involved, by Love Peace Skin Aesthetics staff.
Although it is impossible to list ever potential risk and complication, I have been informed of possible benefits, risks, and complications, including but not limited to: unsatisfactory results, soreness, poor healing, discomfort, redness, blistering, nerve damage, scarring, infection, change in skin pigmentation, allergic or histamine reaction, muscle damage, and increased hair growth. I understand that although precautions may be taken in my treatment, not all risks can be known in advance. I also recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require further treatments of the treated areas to obtain the expected results at an additional cost.
I understand that any massage I receive is provided for the basic purpose of relaxation and is allowed under the esthetician’s scope of practice. If I experience any pain or discomfort during the session, I will immediately inform the therapist so that the pressure and/or strokes may be adjusted to my level of comfort. I further understand that massage should not be construed as a substitute for medical examination, diagnosis, or treatment. I understand that estheticians are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such. Because massage should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the therapist updated as to any changes in my medical profile during the session and understand that there shall be no liability on Love Peace Skin Aesthetics, LLC or the therapist’s part should any party fail to do so. I understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session. I also understand that the Licensed Esthetician reserved the right to refuse to perform massage on anyone whom he/she deems to have a condition for which massage is contraindicated.
I understand that the services offered are not a substitute for medical care and any information provided by the aesthetician is for educational purposes only and not diagnostically prescriptive in nature. I understand that the information herein is to aid the therapist in giving better service and is completely confidential.
I understand how important it is to follow all instructions given to me for post-treatment care. In the even that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care, I will consult the esthetician immediately.
I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies, prescription, or recreational drugs or products I am currently ingesting or using topically. I have fully disclosed on my client intake form any previous complications, or current conditions that my affect my treatment. I understand and agree that any legal action of any kind related to any treatment I receive will be limited to binding arbitration using a single arbitrator agreed to by both parties.
I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. Given the above, I understand that response to treatment varies on an individual basis and that specific results are not guaranteed. Therefore, in consideration for any treatment received, I agree to hold harmless and release from any and all liability Love Peace Skin Aesthetics, LLC and the esthetician that provided my treatment, the insured, and any additional insureds, as well as any offers, directors, or employees of the above companies for any condition or result, known or unknown, that may arise as a consequence of any treatment I receive.