Please read carefully and initial:
I have not used retin-A for 72 hours
I do not have any active cold sores.
I acknowledge that there is a rare possibility of an allergic reaction. I have previously used alphahydroxy acid products on my skin and/or in the past with no allergic reaction, but understand there still could be a response.
I agree to avoid direct sun exposure for 48 hours.
I agree to notify my esthetician of any concerns.
I agree not to wax for 72 hours pre/post treatment.
There will be a $50 charge for patients who aren't shaved and need shaving. Your appointment may have to be rescheduled if you do not come shaved and our schedule does not allow enough time to perform your treatment.
We have a 24-hour cancellation policy. You will be changed full price for all appointments that are a no show and $25 for appointments that are cancelled in less than the 24 hour period. You must have a credit card on file at all times while receiving treatments at Blue Divine due to this cancellation policy. No refunds.
Please read carefully, complete, sign and date this form prior to your treatment.
City: State: Zip:
• If you answered YES to any of the above questions please explain:
Please list any known allergies:
CLIENT CONSENT FORM (Initial each acknowledgement line below)
1. I acknowledge that my skin might experience temporary irritation, tightness, or redness, which usually dissipates within 72 hours depending on skin sensitivity.
2. I acknowledge that if I fail to use a minimal sunscreen (SPF 30) and follow the direction for use, I am more susceptible to sunburn, sun damage & hyperpigmentation. I should avoid excessive sun exposure, especially between 10am - 2pm.
3. I have disclosed my history of allergies above and I acknowledge that if I am allergic to one or more of the ingredients in the products used, I may experience an allergic reaction.
4. I hereby agree to have the treatment performed and agree to follow all pre and post treatment instructions.
5. I acknowledge that I have answered all questions truthfully and completely.
6. I release Edge Systems, the Aesthetician/Doctor, management and staff of Blue Divine Aesthetics (Clinic/Office) from any and all liability associated with any injuries and/or current or future conditions resulting from the skincare procedures or products.
7. I consent to the use of my before, during and after facial procedure photographs for education, promotion or dvertising purposes. My name will not be used to identify these photographs without my written approval.
By signing below, I certify that I have read and fully understood the contents of this consent form, and that the information I provided above are complete, accurate, and up-to-date to my knowledge.