DESCRIPTION OF THE NANOFACIAL:
The Rezenerate NanoFacial System allows the targeted products/serums chosen by you and your skin care professional to reach maximum efficacy! The intended result is typically smoother, firmer and younger looking skin, but any number of results can be achieved depending upon the chosen serum/products used. Rezenerate NanoFacials are performed in a safe and precise manner with the use of sterile Rezenerate components. (All serum/products should be discussed separately with your skin care professional.)
POTENTIAL SIDE EFFECTS:
I recognize there are no guaranteed results and that results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require further NanoFacials to obtain the expected results at an additional cost. After the NanoFacial, in rare cases, the skin will be pink and flushed in appearance. You may also experience skin tightness and mild sensitivity to touch or sweating on the facial area.
CONTRAINDICATIONS:
Contraindications include: Keloid scars; active inflammatory conditions; sun burnt or blistered skin; Accutane users; severely barrier compromised/chapped skin; history of actinic (solar) keratosis; history of active Herpes Simplex infections; history of diabetes; presence of raised moles, warts on targeted area; scleroderma, collagen vascular diseases; blood clotting problems; active bacterial or fungal infection; immuno-suppression. Not recommended for women who are pregnant or nursing.
CLIENT CONSENT:
I understand that results will vary between individuals. I understand that although I may see a change after my first Rezenerate NanoFacial; I may require a series of Rezenerate NanoFacials to obtain my desired outcome. I understand that the Rezenerate NanoFacial is a cosmetic treatment, not a medical procedure.
The Rezenerate NanoFacial and any potential contraindications or side effects have been explained to me to my complete satisfaction.
I am advised that though good results are expected, the possibility and nature of complications cannot be accurately anticipated and that, therefore, there can be no guarantee as expressed or implied either as to the success, or any other result of the Rezenerate NanoFacial, and I hold Rezenerate and my skin care professional harmless for any undesired effect.
I state that I have read (or it has been read to me) and I understand this consent and I understand the information contained in it.
I have had the opportunity to ask any questions about the Rezenerate NanoFacial including risks or alternatives and acknowledge that all my questions about the NanoFacial have been answered in a satisfactory manner.
MODEL RELEASE
Release of Photograph, Use of Likeness or Printed Quotes or Statements.
I do hereby grant permission to Rezenerate, LLC and its employees or representatives, to take and use; photographs, video and/or digital images, and printed statements for use in promotional or educational materials pertinent to the Rezenerate NanoFacial as follows:
• In printed publications or materials
• In electronic publications or presentations
• On the Rezenerate website (www.rezenerate.com)
I agree that Rezenerate may use such items of me for any lawful purpose, including such purposes as publicity, illustration, advertising, educational videos and web content.
I have read and understand the above.
THIS CONSENT & MODEL RELEASE FORM SHALL BE VALID FOR ALL REZENERATE NANOFACIALS I RECEIVE