I understand that facial services are not a substitute for medical care. I will seek medical care (at my expense) and contact my aesthetician immediately if an allergic or adverse reaction occurs.
I understand that my aesthetician will inform me what to expect in the course of treatment and will recommend adjustments to my regimen if deemed necessary. In order to receive maximum benefits from facial services, more than one application may be required. A series of treatments may be recommended and customized based on the advice of my aesthetician.
I understand that the rate of improvement from facial services depends on my age, skin type and skin concern. This includes, but is not limited to, the degree of environmental damage incurred, pigmentation levels, or acne condition.
I will follow pre- and post- facial treatment instructions and maintain appointment schedules as they are recommended. This includes the application of home care and taking the proper measures to help prevent sun exposure/damage.
I acknowledge that no guarantee has been made about the results of the facial service. I have been informed of some possible benefits, risks and complications which may include, but are not limited to, softer skin texture, reduction in the appearance of lines and wrinkles, reduction in acne lesions, swelling and redness, scabbing, peeling or sloughing, prolonged sensitivity to the environment and sun exposure, and increased or decreased pigmentation.
I understand that there may be a chance of discomfort during the facial service and there is a minimal risk of permanent skin damage.
I agree to inform my aesthetician of any changes in my health, prescription medications (topical and oral), and skin care regimen changes during the course of treatment.
(Women) I am not pregnant or nursing, or trying to conceive a child.
I have not used Accutane (or like prescription) ever or within the last 12 months.
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 disclosures. 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 Skin Rejuvenation Clinique, Inc (DBA Blown Beautiful) and/or the technician from liability and assume full responsibility thereof.