Microcurrent Consent Form
Do not receieve microcurrent service if ANY of the following contrindications apply:
· Epilepsy or Subject to Seizures · Recent Facial or Other Surgery · Pacemaker or Electrical Implanted Device · Active Cancer · Pregnancy · Under the age of 18
Sigining below indicates that you are aware of the contrainications and confirm that none of them apply to yourself.
[today's date]