Facial Consent form
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Any recent surgery on your face, neck, and shoulders?
Are you a diabetic?
Do you use a tanning bed?
Do you currently wear contact lenses?
Please select the following conditions you have/had experienced?
Please select that following that best describes your skin type:
I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosure. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. The treatments I receive here are voluntary and I release the esthetician from liability and assume full responsibility thereof and I agree to the terms of service.

Thanks for submitting!