Facial Treatment

CONSENT / WAIVER
Although every precaution will be taken to ensure my safety and well-being before, during, and after the facial treatment, I am aware of the following information and possible risks. Please read and initial:
I hereby consent to and authorize MD BEAUTISTRY to perform the facial treatment(s) booked and/or discussed, and I agree to hold MD BEAUTISTRY harmless and nameless from any liability that may arise as result of treatment.
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I have voluntarily chosen to undergo this treatment/procedure after the nature and purpose of this treatment has been explained to me, along with risks and hazards involved by MD BEAUTISTRY.
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I understand that I will need to remove all jewelry prior to any procedures/services requiring any electrical devices (such as: high frequency, LED light therapy) and will be unable to have this procedures performed if I cannot remove all facial & bodily jewelry and if I have any metal implants/pins/plates or a heart pacer in/on my body.
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I understand that I will be lying in a reclined position. Any medical conditions that might be aggravated by lying for a prolonged period of time may mean that I will not be able to have the procedure performed.
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I have read and understand the post-treatment home care instructions. I understand how important it is to follow all instructions given to me for post-treatment care. In the event that I may have additional questions or concerns regarding my treatment or suggested home product(s)/post-treatment care, I will consult my esthetician immediately.
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I understand that it is imperative that I disclose all of the information requested on the Client Intake Form and that it is my responsibility to inform my esthetician if I have any medical conditions now or in the future or any changes to my medical history.
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I have cited all conditions and circumstances regarding my health history, medications being taken, allergies and any past reactions to products or medications.
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I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically.
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I agree that if I experience any issues that I will contact the technician that performed this procedure. I understand that there is a possibility I may need to consult a physician and will do so at my own expense.
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This agreement will remain in effect for this procedure and all future facial procedures by my technician, MD BEAUTISTRY. I understand that this agreement is legal and binding and that I have read and fully understand all information above.
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I release my technician, MD BEAUTISTRY, from all liability associated with this procedure. There are no guarantees for results of this procedure. MD BEAUTISTRY is not responsible for any technician errors. I understand that I have been advised to follow the aftercare protocols from my technician so as to avoid any discomfort or adverse side effects after the procedure has been completed.
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By signing below, I hereby acknowledge that I have read and fully understand the above agreement. I have completed this form to the best of my knowledge and agree to inquire about any questions I may have before MD BEAUTISTRY begins performing the procedure. I have been informed of and understand the contraindications to the requested treatment(s) and confirm that I do not have any condition(s) that would make the requested treatment unsuitable. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I agree to waive all liabilities towards MD BEAUTISTRY for any injury or damages incurred due to any misrepresentation of my health history.
Client Name (printed)
First & Last
Client Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

MD BEAUTISTRY POLICIES

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I am 18 years of age or older. (You must be 18+ to book an appointment.)
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All appointments require a non-refundable deposit. Appointment slot will not be held and is not secured until deposit is sent.
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I am able to reschedule once only per deposit and must notify my technician at least 48 hours before my scheduled appointment time in order to transfer it and not lose the deposit. New appointment must be rescheduled within a month (30 days) to not lose the deposit.
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I understand that the deposit is non-refundable, meaning that the deposit amount will not be refunded/sent back to me regardless of circumstance.
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I must be following MD BEAUTISTRY on Instagram (@md.beautistry) with a personal account (no spam accounts or accounts with no followers, posts, or profile picture) to book an appointment.
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I understand that if I am late, the time will be deducted from my appointment accordingly and may result in exclusion of some treatment steps. I am still responsible for paying the full price of the service booked.
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If I no-show (not showing up to appointment without any notice or update), the deposit is forfeited and I must send a $20 no-show fee to move forward with a new appointment. A new deposit (that will go towards the service) must still be made. If I do not agree to this, I will no longer be allowed to book.
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I understand that MD BEAUTISTRY has a no additional guest policy (this includes but are not limited to: friends, significant others, parents). The only exception is if the individual has an appointment right before/after yours and MUST wait in the waiting area during your service.
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I agree to avoid consumption of caffeine (coffee, tea, soda, pre-workout, etc.) at least 12 hours before.
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I understand that MD BEAUTISTRY carries a NO REFUND POLICY for services and products.
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If I experience an allergic reaction to any of the products used during the procedure, I will consult a physician at my own expense.
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NO REFUNDS, NO EXCEPTIONS.
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By signing below, I hereby acknowledge that I have read and fully understand all information and the statements in the agreement above.

This agreement will remain in effect for this procedure and all future procedures of the same nature conducted by MD BEAUTISTRY. I understand that this agreement is legal and binding. I am over 18 years of age and consent to the agreement and to all policies regarding facial treatment services and appointments.
Client Name (printed)
First & Last
Client Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

PHOTO AND VIDEO RELEASE

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I hereby grant and authorize MD BEAUTISTRY the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures, videos, and/or audio taken of me to be used in and/or for any lawful promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, websites, social media sites and other print and digital communications, without payment or any consideration.
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This authorization shall continue indefinitely and extends to all languages, media, formats and markets now known or later discovered.
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I waive any rights to royalties or other compensation arising or related to the use of the photograph or recording.
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I hereby hold harmless and release MD BEAUTISTRY from all liability, petitions, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.
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By signing below, I hereby acknowledge that I have completely read and fully understand the above release agreement.
Client Name (printed)
First & Last
Client Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

FACIAL TREATMENT

CLIENT INTAKE

CONSENT / WAIVER

MD BEAUTISTRY POLICIES

PHOTO AND VIDEO RELEASE