I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that is supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contradications and/or irritation to the skin from treatments received. The treatments I receive here are voluntary and I release this institution and/or the technician/esthetician/skin care professional from liability and assume full responsibility thereof.