Skin Care Consent Form

Skin Care Consent Form
Client's Name

First NameLast Name
Phone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Selected Procedure
Risks. There are risks in this type of treatment and your Esthetician will explain everything to you. This is a non-invasive procedure however consent is always needed from the client.

Confidentiality. All data gathered from this form will be kept confidential and will not be released to anyone without your consent.

Questions. If you have any questions, please do not hesitate to contact me at (831) 236-1838 or email me at tiffany@thepeninsulafacialist.com
I authorized Tiffany Newman to perform the treatment or procedure I've selected.I confirmed that I am of legal age and I'm not under the influence when I signed this consent.I authorize the use of professional chemical peels and electric modalities.I understand the risks and hazards of this procedure and I agree to proceed.I confirm that I didn't undergo any facial waxing and chemical peeling within two weeks.I confirm that there's no guarantee for the treatment results.I understand the post-treatment home care or clinical care and I will follow it.I release Tiffany Newman, The Peninsula Facialist, for any responsibility in case of an accident, illness, or injury.I agree that all information listed below or from another form is accurate and true.I confirmed that I do not have any existing medical conditions that can affect the procedures.I confirmed that I have read the statements above and asked any further questions.
Date Signed

MonthDayYear
Date
Client Signature

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