By SUBMITTING AND SIGNING THIS FORM, I acknowledge, consent, and agree to the following:
I give my permission to receive facials, skin care treatments, and eyebrow services or waxing services.
I understand that the esthetician does not diagnose illnesses or injuries or prescribe medications.
I have clearance from my physician or other professionals treating me to receive facials, skin treatments, and waxing services.
I understand the risks associated with facials and waxing include, but are not limited to:
• Superficial bruising or redness
• Short-term muscle soreness
• Exacerbation of undiscovered injury
I acknowledge that my skin might experience temporary irritation, tightness, redness, or slight swelling which usually dissipates within 72 hours depending on skin sensitivity.
I acknowledge that if I am allergic to one or more ingredients in the products used, I may experience allergic reactions.
I acknowledge that if I fail to use a minimal sunscreen (SPF 30), I am more susceptible to sunburn, skin damage & hyperpigmentation. I should avoid excessive sun exposure.
I acknowledge that this treatment is strictly an elective cosmetic procedure and no medical claims have been expressed or implied.
I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, waxing, and products containing acids that are not part of the recommended take-home regimen following treatment.
I understand the importance of informing my esthetician of all medical conditions and medications I am taking, and to let the esthetician know about any changes to these. I understand that there may be additional risks based on my physical condition.
I understand that it is my responsibility to inform my esthetician of any discomfort I may feel during the session so she may adjust accordingly.
I understand that I or the esthetician may terminate the session at any time.
I have been given a chance to ask questions about the session and my questions have been answered. I have reviewed the Skin by Cynthia FAQs on the website which can also be found here.
I understand there is a $65.00 deposit required per appointment that will be applied to my full service charge. I also understand that if I reschedule or cancel less than 72 hours in advance, I will be charged the full-service amount and I forfeit my deposit. Another deposit will be required when and if I reschedule.
I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications 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.
I am at least 18 years of age OR if I am not 18 years of age my legal guardian is present and giving their full consent.
I, therefore, release Cynthia Delgado, Skin by Cynthia, and its staff of from all and any liability associated with any injuries and /or current and future conditions resulting from the skincare procedures or products.