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.