Please read each section and Initial where indicated. Signature and date are required on each form. If customer is under 18, form must be signed by a legal guardian.

1. I understand that I should not have this procedure if I intend to continue to have excessive sun exposure. It has been explained to me that the treated area will be more sensitive to the sun as a result of the treatment and will require regular use of sunscreen.

2. I understand that this procedure may make the skin feel uncomfortable while being applied, but agree to inform the Aesthitician immediately if I have concerns or am overly uncomfortable during treatment or after I return home.

3. I understand that my skin will be flushed and red and I may experience minor discomfort, ie: itchiness, irritation and stinging.

4. The majority of our clients receive noticeable, satisfactory to above average results with a series of treatments and a commitment to a daily skin regimen. However, this outcome cannot be guaranteed as maximum results. Maximum results are highly dependent on age, cumulative sun exposure, health, lifestyle, genetic traits, general skin conditions, and willingness to follow recommended protocols.
Be aware that many changes may occur deeper within the skin over time. To continue the maintenance of your skin after you complete your treatment(s), I may inform you of long-term age management programs.

5. Contraindications – Although it is impossible to list every potential risk and complication, the following conditions are recognized as contraindications for resurfacing treatment and must be disclosed prior to treatment.
Please check if you have:

6. Post Treatment Home Care – Aerobic exercise or vigorous physical activity should be avoided until all redness has subsided. Direct sunlight exposure is to be completely avoided immediately following the treatment (including any strong UV light exposure or tanning beds). Although SPF 30+ should already be a part of your daily skin care, after resurfacing procedure, an SPF 30+, such as Marini Physical Protectant,  must be applied daily to the treated area for a minimum of two weeks. Twice daily, cleanse, do not scrub, with a gentle cleanser, like Cleanzyme or C-esta. Apply a light moisturizer as often as needed to relieve dryness and tightness. Do not have any other facial treatment for at least one week after your resurfacing treatment.

7. I, or my legal guardian, have read the above information and initialed each section to indicate that I fully understand what to expect. If I have any concerns, I will address these with my Aesthetician. I give my permission to my Aesthetician to perform the resurfacing procedure we have discussed and will hold her and Beau Visage harmless from any liability that may result from this treatment. I understand every precaution will be taken to minimize or eliminate negative reactions such as blisters, sores, or other reactions. I have given an accurate account of any over the counter or prescription medications that I use regularly and I am not presently using isotretinoin (Accutane). I have not had any facial surgical procedures or other chemical peels or skin treatments that I have not disclosed to my esthetician. I am not ingesting or using topically any other over the counter product or lactating and I am over the age of eighteen (18). I have not had any recent radioactive or chemotherapy treatments, sun burn, windburn, or broken skin. I have not recently waxed or used a depilatory (such as Nair) on the area to be treated. I have discussed any history of keloidal scarring, excessive telangiectasia, rosacea, bacterial skin infections, fungal infections, viral infections, open lesions or rashes, active acne, any auto immune diseases, or any other existing conditions that may interfere with the positive outcome of this treatment.

I consent to the taking of photographs to monitor treatment effects, as desired or recommended by the Aesthetician.

I agree that I am willing to follow recommendations by my Aesthetician for home care. I will be responsible for following home regimens that can minimize or eliminate possible negative reactions, including recognizing the importance of adhering to a sunscreen and avoiding sun/tanning booths and extreme weather conditions. I agree to use a moisturizer specifically recommended by my Aesthetician and I acknowledge that I have been informed of the possible negative reactions and the expected sequence of the healing process (dryness, irritation, redness, and peeling, of the skin). In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care, I will consult my Aesthetician immediately.

I understand the potential risk and complications and have chosen to proceed with the treatment after careful consideration of the possibility of both known and unknown risks, complications and limitations. 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.