Parental Consent for Treatment of Minor

Parental Consent for Treatment of Minor
Parent's Name*

First NameLast Name
Parent's Email*
Parent's Phone Number*
Please enter a valid phone number.
Name of Minor Being Treated*

First NameLast Name
Birth Date of Minor*
Please enter a valid phone number.
Phone Number of Minor Being Treated *
Please enter a valid phone number.
I, Name of Parent/Guardian*, consent to Beauté Aesthetics performing laser aesthetic treatments for Patient First Name* Patient Last Name*. I hereby certify that I have provided all necessary medical information and signed all client consent forms on behalf of the above named patient.
All my questions/concerns have been addressed.*

Yes
I have been advised that since the patient is under the age of 16, he/she may not see results or results may not last long-term.*

Yes
I give Beauté Aesthetics and it's staff permission to provide aesthetic treatments to the above named minor without my presence.*

YesNo
Signature*

Clear
Date*

MonthDayYear
Date
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