• Med Spa Intake

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  • I consent to my picture being taken for Before and After comparison for provider use only.  
    I consent to my FIRST name and/or likeness being used on Arctic Medical Center Website and Social Media Pages.  

  • I certify that the above information is correct to the best of my knowledge. I will not hold my doctor or any members of the staff responsible for any errors or omission that I may have made in the completion of this form.

  • Clear
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  • Aesthetics Informed Consent

  • I,    give my consent for any and all aesthetic procedures to be performed by a provider at Arctic Medical Center. 

    I agree with

    • If I experience any pain or discomfort during the session, I will immediately inform the esthetician/massage therapist so that the products and/or technique may be adjusted to my level of comfort.
    • I further understand that facial or massage should not be construed as a substitute for medical examination, diagnosis, or treatment.
    • I understand that estheticians are not qualified to perform, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such.
    • I agree to keep the esthetician updated as to any changes in my medical profile during the session and understand that there shall be no liability on the aestheticians’ part should I fail to do so.
    • I understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session.


    Also, I understand that;

    • The services offered are not substitutes for medical care, and any information provided by the therapist is for educational purposes only and not diagnostically prescriptive in future.
  • Clear
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