I understand and agree the information I provided above is true and correct. I also understand that all information stated is strictly confidential and will not be shared outside this facility due to HIPPA regulations. Please Note, that waxing can have certain side effects such as skin removal, redness, swelling, tenderness. I take every precaution to avoid any reactions, it is equally important that you inform me of any change in medication or topical treatment prior to starting any treatment. I have read the above information and if I have any concerns, I will address these with my skin therapist. I give permission to my skin therapist to perform services as we have discussed and will hold her harmless from any liability that may result from this treatment.
I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I'm currently taking/using topically. I understand the esthetician will take every precaution to minimize or eliminate negative reactions. I have read and understand the post-treatment care instructions (If applicable). I'm willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home/post-treatment care, I will consult the esthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify I have read, and fully understand the above. I understand the procedure and accept the risks. I do not hold the esthetician (Monica Torres/M Esthetics), responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.