Hydrafacial Consent Form

Name

First NameLast Name

Birth Date

MonthDayYear

Email

example@example.com

Phone Number

Please enter a valid phone number.

Please read each section carefully and check the near box to acknowledge

I understand that the practitioner will perform a hydrafacial treatment on my face, neck, and/or other areasThe nature of this service and the potential risks involved have been explained to meI acknowledge and confirm that I have NOT had any tanning, waxing, or microdermabrasion 2 weeks prior to this serviceI understand that I should not tan, wax, exfoliate, avoid acids and retinol, or seek cosmetic treatment for at least 2 weeks after receiving this treatmentI understand that I must wear spf 30+ with broad spectrum coverage to protect my skin during sun exposure but agree to limit sun exposure for 72 hours post treatmentI understand I must avoid excessive sweating and strenuous activities for at least 24 hoursI acknowledge and accept that I may experience some of the following side effects including redness, irritation, and tightening

I hereby release the practitioner and the company in which I am voluntarily seeking services from and waive on behalf of myself, my heirs, and any personal representatives and all causes of action, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act, or misinformation both intentional or accidentally on this form as well as failure to follow post-care instructions after my service.

Date

Signature