Facial Waiver Consent Form
Please review and sign to consent to facial procedures
Participant Full Name
*
First Name
Last Name
Has there been any recent changes in your health history? If yes, please discribe.
In the past 48 hours have you,
Had any exfoliation on your face?
Used any actives AHA’s(glycolic, lactic, mandelic acids), BHA’s(salicylic acid) ?
Used Retinol, Retin-A, Renova?
In the past 5 days have you?
Had any waxing or depilatories on your face?
Had and laser treatments on your face?
Had excess exposure to the sun?
In the past two weeks have you had any filler or Botox?
Yes
No
Have you used Accutane in the past 6 months?
Yes
No
Treatment consent
I understand that I am receiving a facial treatment, which may include cleansing, chemical exfoliation, masks, LED therapy, and/or professional skincare products.
I acknowledge that, results vary person to person, temporary reactions such as redness, sensitivity tingling, dryness, or breakouts(purging) may occur. No guaranteees have been made regarding results. I have disclosed all relevant medical conditions, medications, and skincare use. I understand that failure to disclose information may increase the risk of adverse reactions. I understand that certain conditions or products may require modifying or postponing treatment. I agree to follow all pre and post-treatment instructions, including sun protection and home care recommendations. I voluntarily consent to this treatment and release my esthetician Maria Guillen and Reeset Esthetics from any liability related to adverse reactions that may occur, provided the treatment is performed according to professional standards.
Consent of Photography (optional)
I consent to before/after photos for educational or marketing purposes
I do not consent to photos
Date
*
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Month
-
Day
Year
Date
Signature
*
I Consent
I Consent
Should be Empty: