I have read the above information. If any concerns, I will address these with my skin therapist. I give permission to my therapist Mari van Schalkwyk to perform the tinting procedure we have discussed, and I will hold her harmless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand my aesthetician will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my treatment, I will consult the aesthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above paragraphs, and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold Mari van Schalkwyk responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affectet by the treatment performed.