I hereby consent to and authorize Tiffany Santos (Esthetician) with The Spa at Tiffany's, LLC. to perform the above procedure. I have voluntarily elected to undergo this treatment/procedure after the nature and purpose of this treatment has been explained to me, along with the risk and hazards involved.
Although it's impossible to list ever potential risk and complication, I have been informed of possible benefits, risk, and complications. I also recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require further treatments of the treated areas to obtain the expected results at an additional cost.
I have read and understand the post-treatment home care instructions. I understand how important it is to follow all instructions given to me for post-treatment care. In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care, I will consult the esthetician immediately.
I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically.
I'm also aware that there are no refunds, no splitting packages, and no show appointments are charged 100% of the menu price. Cancellations that aren't notified within 24 hours will be charged 50% of the menu price. If I have a package and cancel under 24 hours or do not show up for the appointment, one will be taken off of the package. Prices subject to change.
I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I do not hold the esthetician, or The Spa at Tiffany's, LLC. 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.