Facial Consent Form printable pdf download

Facial Consent Form

I hereby consent to and authorize _________________________ to perform the following procedure:

(esthetician)

I have voluntarily elected to undergo this treatment/procedure after the nature and purpose of this

treatment/procedure after the nature and purpose of this treatment has been explained to me, along with

the risks and hazards involved, by ____________________________________.

(esthetician)

Although it is impossible to list every potential risk and complication, I have been informed of possible

benefits, risks, and complications. I also recognize there are no guaranteed results and that independent

results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require

further treatments of the treated areas to obtain the expected results at an additional cost.

I have read and understand the post-treatment home care instructions. I understand how important it is to

follow all instructions given to me for post-treatment care. In the event that I may have additional

questions or concerns regarding my treatment or suggested home product/post-treatment care, I will

consult the esthetician immediately.

I have also, to the best of my knowledge, given an accurate account of my medical history, including all

known allergies or prescription drugs or products I am currently ingesting or using topically.

I have read and fully understand this agreement and all information detailed above. I understand the

procedure and accept the risks. All of my questions have been answered to my satisfaction and I consent

to the terms of this agreement. I do not hold the esthetician, whose signature appears below, responsible

for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which

may be affected by the treatment performed today.

______________________________________________________________________

Client Name (printed)

______________________________________________________________________

Client Name (signature)

Guardian Signature __________________________________________________

Date___________________

(if client is under 18)

Esthetician _________________________________________________________ Date __________________

Facial Consent Form