Virtual & In-Clinic Consultation - Skin Investment Consent FormThis consultation is designed for clients who are serious about improving their skin and are financially prepared to invest in a customized treatment plan that gets results.

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date Of Birth*

Date

What is your current budget for professional-grade skincare products? (Please note that effective skincare requires an investment, and your treatment plan will be tailored to your budget.)*

If you qualify for financing, how much are you comfortable spending monthly on skincare and treatments? (Select one)*

If your skincare budget is $100/month or less, please make sure to pre-qualify through Cherry before booking your consultation.

We do not offer personal payment plans at Leslie Skin Technique Advanced Skin Care you must use our Cherry partners.

If $100/month is your max, financing must be secured through Cherry in advance. Otherwise, we won’t be able to move forward with a custom treatment plan, as our plans typically start at $200+.

If your Cherry approval is under $200, you will need to have additional funds available to match your plan, as most treatment programs begin at $200+

If you need the link to apply for Cherry, please refer back to the original text message where you received this form.

Questions? Text us at (786)436-0707.

Have you checked to see if you pre-qualify for financing of at least $200+?*

Please Read:

While some clients may only need professional-grade skincare products to improve their skin.. which typically start around $200. Others may require a combination of products and professional treatments to fully address their concerns.

These treatments, which can be done virtually or in-clinic, include options like chemical peels such as the Cosmelan Peel, which can bring your total investment to $2,000–$3,000+, depending on what your skin needs.

We’ll determine the best plan for you during your consultation, but we recommend pre-qualifying through Cherry in case your skin requires more than products alone.

I understand that while product plans start at $200+, full treatment plans may reach $2,000–$3,000+ depending on my skin’s needs.*

When do you plan to start your skincare journey?*

Are you ready to purchase the recommended skincare products on the day of your consultation? (If not, please book at a later date when you are ready to invest in your skin.)*

Acknowledgment & Payment Policy*

Signature

DISCLAIMER

At Leslie Skin Technique Studio, we strive to provide the highest quality corrective skincare treatments to help address and improve various skin concerns, including acne. However, it is important to understand that individual results may vary and cannot be guaranteed. All treatments and products recommended are based on standard protocols and are tailored to each client's specific skin condition. While we aim to achieve the best possible outcomes, factors such as individual skin type, lifestyle, and adherence to recommended skincare routines can influence the effectiveness of treatments.

By receiving services at Leslie Skin Technique Studio, you acknowledge and accept that:

Results May Vary: There is no guarantee that the treatments will achieve the desired results. Each person's skin responds differently to treatments and products.

Client Responsibility: Following aftercare instructions and maintaining a consistent skincare routine as advised by our professionals is crucial for optimal results. Leslie SKin Technique Studio is not liable for any adverse reactions or less-than-expected outcomes that may occur. Clients should disclose any medical conditions, allergies, or concerns prior to receiving treatments.By proceeding with our services, you agree to this disclaimer and understand the potential risks and variability of results.

Rescheduling: Clients are required to provide at least 24hours' notice for appointment rescheduling to avoid the missed appointment fee. Appointments or cancellations made less than 24 hours in advance will result in a $50 fee charged to the card on file. By signing this form, you authorize Leslie Skin Technique Studio to charge your card accordingly.

Return or Exchange on Products:

We do not offer refunds or exchanges on any products or services. Once it leaves our clinic it cannot be returned. If you have a defective product or damaged product from shipping please bring it to the spa so we may exchange it with the company. Or if you are virtual, please email Leslie.Health.Wellness@gmail.com with photos or videos of the damaged merchandise.

Treatment Package Policy:

Treatment Packages such as facial packages, peel packages, microneedling packages, etc. are not refundable once purchased. Credits may be used towards any other services offered at Leslie Skin Technique Studio.

Late Arrivals: Clients who arrive more than 15 minutes late may be required to reschedule their appointment, and the missed appointment fee may apply.

Virtual Consultations: Virtual consultation appointments must be confirmed at least 24 hours in advance. Failure to confirm may result in cancellation of the appointment.

Consent for Use of Photos/Videos:

I give Leslie Skin Technique Studio permission to use my before-and-after images, video footage, and results-based transformation photos for promotional and educational purposes. This includes use on the company’s website, social media, digital advertising, and other public-facing marketing content. I understand that even if identifying details (e.g. my eyes, name, voice) are removed or blurred, the results themselves may still be recognizable to others. I understand that content shared publicly may be viewed, saved, or reposted by other entities, such as blogs or media platforms, and I will not hold Leslie Skin Technique Studio responsible for third-party distribution or reposts. I understand that once I give consent for my images or videos to be used, that permission cannot be revoked after content has been published or shared.I acknowledge that Leslie Skin Technique Studio may use this content for promotional and educational purposes, and I waive the right to request removal once posted.

Treatment Agreement:
With this signature below, I give consent to receive treatments to my service provider and have read and completed this questionnaire truthfully, I understand I will be receiving a professional service from a licensed service provider. I further understand that the service provider neither diagnosis illness, disease, or any other medical, physical, or mental disorder. I am responsible for consulting a qualified physician for any ailment that I have. Because the service provider must be aware of any existing medical or physical conditions I may have, I have listed all my known medical conditions and physical limitations and I will inform the specialist in writing of any changes in my physical health. I agree that this constitutes full disclosure. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. If any information changes
between my appointments, I will let my service provider know. I understand that there shall be no liability on the service provider for any services rendered.

I understand that this consultation form includes information about treatment, pricing, results, communication, and usage of any submitted or captured images as outlined above.*

Name

First NameLast Name

Signature

Date

PLEASE READ BEFORE SUBMITTING

By submitting this form, you confirm that you are financially prepared to invest in clinical-grade skincare and/or treatments, with product plans starting at $200+. If you qualify for financing, flexible payment options may be available.

If you do not make a purchase during your consultation, whether due to financing limits or personal decision, a $50 consultation fee will be charged, which may be credited toward a future purchase.

This is a professional consultation with recommendations and education tailored to you. It is not a free advice session.

If this does not align with your budget at this time, please reschedule your consultation for a later date.

Call or Text at (786)-436-0707