This is a combined consent form for Microdermabrasion, Dermaplaning, Chemical Peel, Waxing and Electric Modalities. We ask to sign this form every 12 months. Please put a check mark next to the service you are scheduled to receive and any additional services for future consideration to ensure no further paperwork will be needed until its 1 year expiration. My esthetician has provided information and answered any questions I have regarding my treatment: expectations, contraindications, allergies, side-effects (bruises, scabbing, scarring, redness, swelling, tenderness, hyperpigmentation, break outs, flare up, dryness/dehydration, peeling, itchiness, irritation, edema, erythema, stinging, burning, nicking, cutting), pre and post care, and precautions. In the event that I may have additional questions or concerns regarding my treatment or suggested home products, post treatment care, I will consult with my esthetician immediately. I acknowledge there are no guarantees as to the results of the treatment, due to many variables, such as: age, condition of the skin, sun damage, hormones, lifestyle, climate, etc. I acknowledge that to achieve maximum results, I may need several treatments as follow post treatment care at home recommended by the estehtician. I acknowledge that I must avoid direct sun exposure following this procedure and will apply sunscreen daily at least for 2 weeks following the treatment. I acknowledge to inform my esthetician about any changes in my skin care, medications, and health conditions prior to the treatment. I give permission to my esthetician to perform the service we have discussed and will hold her and Sage Wellness Spa harmless from any liability that may result from this treatment. I certify that I have read and fully understand this consent form for treatment and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. December 13, 2024
|