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Welcome to Atlanta Acne Specialists!

We want you to have the most beautiful skin possible. By following these requirements you'll achieve the best results with us. Please read each line item below and initial. If you have any questions we're happy to answer them. 

Sincerely,

The Atlanta Acne Specialists Team

1. I will use Atlanta Acne Specialist products exclusively on my acne affected area(s). I understand using other products will limit my results.

2. I will use my full skincare routine twice daily, as directed by my Acne Specialist.

3. If I am unable to give 24 hr notice to cancel/ reschedule my appointment, I give Atlanta Acne Specialists permission to charge my card on file a $50 cancellation fee. 

4. I will be on time to each appointment. After a 5 min grace period my treatment will be shortened. If I am more than 15 mins late we will need to reschedule and the $50 late cancellation fee will apply or for longer treatments I will pay the full amount with a shortened treatment time.

5. I, the person receiving treatment, will fill out the check in forms and will reach out to my Acne Specialist when I need support/ advice, not my parent. Or we will do it together. 

6. I understand that my Acne Specialist does not have a magic wand to get rid of my acne. I am in charge of getting my skin clear by following their instructions.

7. I will make as many of the diet/ lifestyle changes as possible in order to get the results I want.

8. I understand that the products I must use to get rid of my acne also make my skin sentive to the sun. Therefore, I will wear my spf every day.

9. I will not see any other providers for my acne while working with Atlanta Acne Specialists because this will interfere with my progress.

First Client's Name

First Name*

Last Name*

Phone*
First Client's Date of Birth*
I certify that I am 18 years of age or older
First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
teri@atlantaacnespecialists.com
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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