I hereby authorize Apollo Aesthetics LLC, and the professional staff to perform the following treatments and all future facial, dermaplane, microdermabrasion, chemical peel, waxing, and tinting treatments.

Facial treatment includes:

Cleansing. Physical and chemical exfoliation. Steam from the facial machine. Warm facial towels. Various facial masks and scrubs. Extractions. Massage of face, neck, decollate, arms, and hands. Serums. Moisturizer. SPF.

Facial treatment may or may not also include but is not limited to:

Enzyme mask, dermaplane, diamond tip microdermabrasion, chemical peel, galvanic current, high frequency, digital bio-lift microcurrent, electro-desiccating skin spot remover, ultrasonic skin scrubber, brow and lip facial waxing, brow and lash tint/stain, and tweezing of hairs.

• I request and understand dermaplaning is a physical / manual form of exfoliation done by the professional with a surgical blade / scalpel. It is intended to remove the top surface layers of the skin as well as temporarily remove all vellus / peach fuzz hair from the area treated. I understand my hair will grow back naturally how it is and dermaplaning does not cause my facial hair to grow back darker, longer, or fuller.
• I understand that microdermabrasion is an adjustable diamond crystal tip head that feels rough textured and has light suction on the skin. It removes top layers of dead skin cells by forcing the attached dead cells to detach and get suctioned off.
• I understand that chemical peels are expected to make the skin feel warm, sting / burn, and feel uncomfortable during and after application. Chemical peels are a controlled chemical burn to the skin to force the top layers of the skin to peel off. Not all chemical peels physically peel, and that does not mean it isn't working. 
• I understand that facial waxing and waxing in general use melted warm wax to remove / pull hair out of the follicles from the root. Irritation and swelling of the hair follicles will happen in the area waxed. It is important to discontinue the use of retinoid products in the area getting waxed at least 3 days before. 
• I understand that brow and lash tinting / stain use a colored tinted agent and developer to temporarily tint the hairs for up to 6 weeks. It can stain the skin that it is in contact with but will fade quickly and can be rubbed off as much as possible. There is a risk of solution getting in the eyes when treating around the orbital eye area, including the eye itself, and could result in stinging or burning, blurry vision, and potential blindness if not washed out properly and in a timely manner. 
• I understand the possible risks of dermaplaning, microdermabrasion, chemical peels and all other facial treatments noted above including waxing and tinting can cause temporary prolonged redness, mild discomfort / pain, cuts, bleeding, scarring, peeling, skin removal, tenderness, blisters, allergic reaction, infection, irritation, swelling, scabs, bruising, broken capillaries, loss of pigmentation and hyper / hypo pigmentation, burning, scratches, dryness, purging of the pores, etc., and although rare permanent damage can occur. 
• I understand it is the provider's discretion to choose not to perform any of these treatments even if I request, due to skin conditions, health reasons, etc. I also recognize certain areas of the face can not be treated with these treatments. 
• I understand that It is my responsibility to let my provider know if I am pregnant, have any allergies, and are taking any medications. 
• I understand in most cases all forms of retinol and other exfoliants including AHAs, BHAs, benzoyl peroxide, and others must be avoided for at least 48+ hours before getting any of these treatments done.  
• I understand sun exposure and tanning beds need to be avoided at least 48+ hours before getting any of these treatments done. 
• I understand a SPF of 30 or greater is required on the area treated after any of these treatments. The skin treated will burn easier and be more sensitive.
• I understand every precaution will be taken to ensure a safe treatment by my provider, but risks, unknown risks, and allergic reactions to any of the treatments and products are possible. 
• I understand that results vary and multiple treatments over an extended period of time is expected for significant results. Results also depend on age, skin type, skin condition, sun and environmental damage, acne degrees, pigmentation degree, etc., and noticeable results are not promised. 
• I understand it is my responsibility to follow the instructions and recommendations my professional gives me via document or word of mouth to eliminate any possible negative side effects and ensure proper healing.
• We implement HIPAA standards provided by the Health Insurance Portability and Accountability Act to protect your privacy. These rules and restrictions do not include the interchange of information necessary to provide you with our office services, but your PHI will be kept confidential between providers and staff. We will use the communication information you have given us to send appointment reminders and other related information informing you of changes and promotional specials. Your confidential information will not be used for marketing or advertising, but photographs and / or videos are required to have in your record on file for various reasons. I understand that verbal consent is consenting for pictures to be used for promotional / marketing pictures.

I have read the above information and was given the needed information to consent to the treatments above and had the opportunity to ask the necessary questions, which were answered by your provider, for you to make that decision. By signing this form, I acknowledge that I have fully read and understood its contents. I understand that I can call or return to the office at any time with questions or concerns from these treatments. The treatments I receive are voluntary and I release Apollo Aesthetics, LLC and/or the skin care professional from liability associated with these procedures. I certify that I am a competent adult of at least 18 years of age.