II have read the above information and if I have any concerns, I will address these with my skin therapist. I give permission to my esthetician and student in training to perform the wax procedure we have discussed and will hold her and her student harmless from any liability that may result from this treatment. I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.
I have read and understand post treatment homecare instructions. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. 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 agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and expect the risks. I do not hold the esthetician, who performed my services responsible for any of my conditions that were present, but not disclosed at the time of the skin care procedure, which may be affected by the treatment preformed during your appointment.
