AERIS MEDICAL AESTHETICS Consent to Treat a Minor – Aesthetic & Injectable Services
  • AERIS MEDICAL AESTHETICS Consent to Treat a Minor – Aesthetic & Injectable Services

  • 📝 TREATMENTS INCLUDED UNDER THIS CONSENT
    This consent form authorizes Aeris Medical Aesthetics and its licensed staff to perform the following aesthetic or medical cosmetic treatments on the above-named minor, based on provider evaluation and appropriateness:

    Cosmetic injectables (e.g., Botox, Dysport, dermal fillers)
    Acne/skin treatments (e.g., chemical peels, facials, extractions)
    Laser services (e.g., hair removal, BBL/photo-facial, acne treatments)
    Microneedling, LED therapy, or other minor skin services
    Vitamin injections or wellness treatments (if age-appropriate)
    ⚠️ GLP-1 medications, prescription drugs, or hormone therapies are NOT included under this general consent and require a separate medical exam and authorization.

    👨‍⚕️ REQUIREMENT FOR PARENT OR GUARDIAN PRESENCE
    I understand and agree that:

    A parent or legal guardian must be physically present at every appointment where the minor receives treatment.
    No procedures will be performed without the guardian’s in-person approval and attendance.
    I may revoke this consent at any time by notifying Aeris Medical Aesthetics in writing.

    ⚠️ RISKS, LIMITATIONS & RESPONSIBILITIES
    I understand that:

    All aesthetic and cosmetic procedures carry risks including but not limited to: redness, bruising, pain, swelling, allergic reactions, pigmentation changes, and unsatisfactory outcomes
    Injectable results vary by individual, and no guarantees are made regarding outcomes or duration
    Treatments are elective and not medically necessary
    Aeris Medical Aesthetics reserves the right to decline treatment at any time if the provider deems the patient inappropriate for care
    All product and service sales are final; no refunds will be issued once treatment is performed or prepared
    Aeris is not responsible for failure to disclose medical conditions, medications, or allergies

    🛡️ WAIVER OF LIABILITY
    As the legal guardian of the minor listed above, I:

    Give full and voluntary consent for treatments as described
    Accept all potential risks, side effects, and costs
    Release Aeris Medical Aesthetics, its staff, owners, and providers from any liability or claims resulting from authorized services, to the extent permitted by law

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