Aeris Medical Dermaplane Consent Form

You have chosen our NO down-time dermaplane treatment, tell your friends!

Benefits include:

Softer smoother skin

Reduces the appearance of fine lines

Decongests pores and minimizes their appearance

Removal of up to 3 months of dead skin cells

Removal of Valus Hair (peach fuzz) carrying bacteria

Extractions as needed*

Smoother appearance of make-up application

Allows home care products to be more effective

If you've chosen a peel post dermaplane, leave finishing solution throughout the evening.

Date*

Date

Name*

First NameLast Name

Email*

example@example.com

Notify Aeris Medical Aesthetics if you have any questions or concerns at 505-433-4043!*

I Acknowledge and Accept

I understand that although good results are expected, there cannot be any guarantee or warranty, expressed or implied, that I will be completely satisfied by the outcome or that I will not require additional treatment and/or ongoing treatment to achieve the result I seek. I understand that treatments will not cure any medical conditions nor provide immunity against re-occurrence of such conditions. The treatments are temporary and vary per patient with some patients experiencing shorter or longer effects. The number of treatments needed varies per patient and may be affected by the following factors including but not limited to: degree of skin irregularity; severity of volume loss; patient age; personal medical profile; basic metabolic rate; previous cosmetic procedures; history of trauma to the treated area; individual lifestyle choices; and individual patient preference.I understand that all product and service sales are final. No refunds on services or products. I have read and understand all information presented to me before signing this consent form. I have been given an opportunity to have all of my questions answered to my satisfaction. I understand the procedure and accept the risks. I agree to the terms of this agreement.I understand and voluntarily accept the risks associated with all the services provided at Aeris Medical Aesthetics, including but not limited to: Waxing, Facials, Tanning, Injections, Laser Services and skincare products, etc., or the use of any of the location’s facilities. Except where prohibited by law, I acknowledge and voluntarily assume the risk of injury, accident or death which may arise from the use of any skin care products or services performed by Aeris Medical Aesthetics. I agree Aeris Medical Aesthetics will not be liable for death or any injury, including, without limitation, personal, bodily or mental injury, economic loss or damage to me resulting from negligence, other acts of Aeris Medical Aesthetics, anyone acting on Aeris Medical Aesthetics' behalf, or anyone using the services of the facilities of Aeris Medical Aesthetics, to the fullest extent permitted by law.This agreement together with Aeris Medical Aesthetics' post-care plan rules and regulations, constitute the entire agreement between you and us and cannot be amended, except in writing by both parties. Myself and/or any of my heirs, executors, representatives, or assignees hereby release Aeris Medical Aesthetics from all claims or liabilities for death, personal injury or property loss or damages of any kind sustained while on the premises. I agree that this form and waiver is in effect for all services offered by Aeris Medical Aesthetics, and will not expire unless specifically requested by either party.I understand that Aeris Medical Aesthetics is a tranquil and professional environment and that any inappropriate behavior may result in termination of my services and full payment is expected. I also understand that any medical device used by the patient outside of Aeris Medical Aesthetics care or failing to list or mention such medical devices could result in unexpected or unwanted results.By signing this form, I agree to the above terms and release Aeris Medical Aesthetics and its employees from any liability.

I understand and agree.

If you have any questions or concerns please call our office at 505-433-4043

In case of emergency contact your provider.

Amanda Medina- Amanda@aerismedical.info

Lawrence Armijo-Lawrence@aerismedical.info