Client Consent for hair removal

First Name*

Last Name *

Your phone number*

Your E-mail

If you would like to receive our emails.

Date of Birth*

Have you used any Alpha Hydroxy Acid (AHA) or glycolic products in the past 48-72 hours?*

YesNo

Are you using Retin-a, Renova or Accutane (an oral form of Retin-a)? *

YesNo

When was the last time you used it ?

Are you using any other skin thinning products and/or drugs? *

YesNo

What kind?

Do you wear contacts? *

Yes (please remove them prior to your service)No

Are you exposed to the sun regularly or are you considering spending time in the sun soon? *

YesNo

Do you use a tanning bed? *

YesNo

Are you diabetic? *

YesNo

Do you bruise easily? *

YesNo

Do you have any allergies? *

YesNo

Please specify

Are you currently taking medications?*

YesNo

Please list all (including over the counter drugs/herbal supplements):

What kind of skincare products do you currently use?*

I understand, have read and completed this questionnaire truthfully. l agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. l understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. The treatments I receive here are voluntary and I release this institution and/or the technician/esthetician/skin care professional from liability and assume full responsibility thereof.

If at any time I (or the technician) are uncomfortable with the procedure, I will inform the technician and she will gladly rectify the problem, including ending the session if I (or the technician)wishes. It has been represented to me that no guarantees, warranties, promises, commitments or other statements as to the results of this treatment have been made. I acknowledge that I have no particular representation or guarantees and I am consenting to the procedure at my own risk. All conditions must be revealed or disclosed by me to the technician regarding my health history, medications being taken and any past reactions to products used or medications were taken. Additional conditions could be discovered during the procedure, which could affect my ability to tolerate the procedure.

I herein sign, release, give up, acquit, and discharge my technician from any claims or damages of any nature.

I release Sweet Serenity Spa from any responsibility for pre-existing conditions I have not revealed or any consequential change to those conditions that arise subsequent to the procedure. I accept full
responsibility for these and any other complications, which may arise or result during or following the procedure(s), which are to be performed at my request.
I, the client herein signed, certify that I have read and had explained to me
and fully understand the above waiver and release form. I certify that I have consulted with the esthetician of SweetSerenity Spa.
I have provided information regarding my health and medications taken to the best of my knowledge. I accept the explanation of potential complications and risks described herein. I certify I am of sound mind, and fully understand that there might be other unknown risks not reasonably foreseeable at this
time.
I the client herein signed, for the purposes of documentation, hereby consent to “before and after” photographs, which may or may not be used for the purposes of advertising.

By signing below you agree to terms and conditions.

Signature*

Hair Removal