Microcurrent Consent Form

Microcurrent Consent Form
MyoLift is a True Microcurrent device, cleared as FDA OTC and is used for ant-aging and other skincare procedures. The current used is less than millionth of an amp that works in harmony with the body's own electrical system. Microcurrent provides the muscles with very small amounts of electricity causing them to flex and relax. This is a gentle non-invasive treatment that re-educates the muscle. Maintenance is depended on the individual's goals. Increase water intake following the treatment.
Name

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DOB

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Check if you have/had any of the following:
By Initialing and signing below, I acknowledge the following:
I acknowledge that no guarantee has been given to me as to the condition of the complexion, how much firming and toning, skin pore size, wrinkles, or percentage of improvement expected following treatment, due to each individual's reactions.
I have read the above information and thereby consent and agree to receive the micro-current treatment.
All my questions have been acknowledged and answered to my satisfaction.
I consent to before and after pictures. Furthermore, I consent to having my photos used for educational purposes without the use of my name. (optional)
I understand that I must follow the home care regiment recommended by my esthetician.
Signature
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