• Dolce Vita Aesthetics — Skin Lab

    Skin Treatment Consent, Health Disclosure & Non-Refundable Policy
  • Date*
     - -
  •  -
  • Treatment Being Performed*

  • Health & Skin History

    Please check Yes or No:

  • Are you currently pregnant or breastfeeding?*
  • Do you have any known allergies or sensitivities?*
  • Are you currently taking prescription medications, antibiotics, blood thinners, supplements, or herbal products?*
  • Are you currently using retinol, retinoids, tretinoin, exfoliating acids, benzoyl peroxide, or other prescription-strength skincare?*
  • Have you used Accutane/isotretinoin within the past 12 months?*
  • Do you have a history of cold sores, fever blisters, or herpes simplex?*
  • Do you have eczema, psoriasis, rosacea, dermatitis, or another chronic skin condition?*
  • Do you currently have active acne lesions, an infection, open wounds, sunburn, rash, or significant skin irritation?*
  • Do you have diabetes or difficulty healing?*
  • Do you have an autoimmune condition or condition affecting your immune system?*
  • Do you have a history of keloids or abnormal scarring?*
  • Have you recently undergone facial surgery, laser treatment, chemical peels, injectables, or other aesthetic procedures?*
  • Have you experienced an adverse reaction to a facial, peel, microneedling, or other skin treatment?*
  • Is there anything else regarding your health or skin that may affect today's treatment?*

  • Informed Consent

    I voluntarily consent to receive the skin treatment selected above at Dolce Vita Aesthetics.

    I understand that my treatment will be customized based on my skin's appearance, condition, concerns, disclosed health information, and professional assessment.

    I understand that certain products, techniques, devices, exfoliation methods, serums, masks, enzymes, acids, or other topical products may be used when appropriate for my selected treatment.

    The purpose, expected benefits, limitations, potential risks, and appropriate aftercare for my treatment have been or will be explained to me before treatment.

    I understand that my provider may modify, postpone, or decline a treatment if a contraindication or safety concern is identified.

    Possible Side Effects & Risks

    I understand that skin treatments may cause temporary reactions including, but not limited to:

    Redness · Dryness · Flaking · Peeling · Tightness · Tenderness · Swelling · Sensitivity · Itching · Tingling · Bruising · Breakouts · Temporary irritation

    Depending upon the treatment and my individual skin response, other potential reactions may include prolonged redness or irritation, pigmentation changes, post-inflammatory hyperpigmentation or hypopigmentation, infection, scabbing, crusting, allergic or sensitivity reactions, or scarring.

    I understand that certain treatments may temporarily increase my skin's sensitivity to sunlight and skincare products.

    I agree to contact Dolce Vita Aesthetics if I experience an unusual or concerning reaction and understand that medical evaluation may be appropriate for certain symptoms.

    Results & Expectations

    I understand that:

    • Every client's skin responds differently.
    • No specific result or outcome is guaranteed.
    • Results may be gradual and may require multiple treatments.
    • Additional treatments may involve additional costs.
    • Skin conditions can recur or change over time.
    • Lifestyle, hormones, medications, skincare products, sun exposure, health, age, and adherence to aftercare may influence my results.
    • Before-and-after photographs or another client's results do not guarantee that I will achieve the same outcome.

    Aftercare Acknowledgment

    I understand that aftercare varies according to the treatment performed.

    I agree to follow the aftercare instructions provided by Dolce Vita Aesthetics.

    Depending on my treatment, I may be advised to temporarily avoid excessive sun exposure, heat, saunas, steam rooms, strenuous exercise, swimming, exfoliation, retinoids, acids, active skincare ingredients, picking or scratching the skin, and certain cosmetic products.

    I understand the importance of appropriate sun protection following skin treatments.

    I understand that failure to follow recommended aftercare may increase the risk of irritation, pigmentation changes, infection, prolonged healing, or an unsatisfactory result.

    Client Responsibility

    I certify that I have provided complete and accurate information regarding my medical history, medications, allergies, pregnancy status, skincare products, previous procedures, and current skin condition.

    I agree to notify Dolce Vita Aesthetics of any changes before future treatments.

    I understand that withholding relevant information may increase the risk of an adverse reaction or complication.

  • Non-Refundable Treatment Policy

    I understand and agree that ALL SKIN TREATMENTS AND SERVICES PROVIDED BY DOLCE VITA AESTHETICS ARE NON-REFUNDABLE ONCE PERFORMED.

    I understand that individual results vary and that dissatisfaction with the degree of improvement achieved does not automatically entitle me to a refund.

    I acknowledge that:

    • Completed treatments are final and non-refundable.
    • Results cannot be guaranteed.
    • Multiple sessions may be necessary.
    • Additional sessions may require additional payment.
    • Failure to follow recommended pre-treatment or aftercare instructions does not qualify me for a refund.
    • Prepaid treatments, packages, deposits, promotional services, and appointments are additionally subject to Dolce Vita Aesthetics' applicable payment and cancellation policies.
  • Photography Consent (please select ONE)*

  • Final Consent & Acknowledgment

    By signing below, I acknowledge that I have read and understand this consent form.

    I have disclosed relevant health, medication, skincare, allergy, and treatment information to the best of my knowledge.

    I have had the opportunity to ask questions regarding my treatment, expected benefits, limitations, possible side effects, risks, and aftercare.

    I understand that results are not guaranteed and that completed treatments are non-refundable.

    I voluntarily consent to receive the selected Skin Lab treatment at Dolce Vita Aesthetics.

    Client

  • Date*
     - -

  • Provider

    To be completed by Dolce Vita Aesthetics.

  • Provider Date
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