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
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

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Date

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Date
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