Disclaimer: I agree that I will not hold Be Relax and its employees liable for any injury or condition that arises from application esthetics treatment, despite completion of this form. This form is intended as an assessment tool only and serves as a guide for the application of esthetics, not for medical treatment or medical assessment. If I experience pain or discomfort during the session, I will immediately inform the Esthetician so that the pressure may be adjusted. I understand that Estheticians are not qualified to give medical diagnosis, or treatment, and that nothing in the course of the session given should be construed as such. Draping will be used during this session. Only the body area being worked on will be uncovered. Clients under the age of 18 must have a parent or legal guardian present to provide a signature for authorization for the esthetic treatment. I have stated all conditions that I am aware of and this information I provided is true and accurate to the best of my knowledge.
I agree to inform my Esthetician immediately of any change in the conditions stated above. I acknowledge that this information is confidential and intended for review by esthetician; that a medical referral may be requested of me; and that Be Relax is not liable for the management of any condition. I also understand that any illicit or sexually suggestive remarks or advances made by myself will result in immediate termination of this session, and I will be liable for full payment of the appointment. Attention: for the protection of our staff as well as our customers. Conversations are being recorded in private treatment rooms.
I consent to give Be Relax the authorization to create my customer profile on their POS system in order to receive a digital copy of this form and of my receipt.