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