Skin Treatment Waiver Form
Please read and sign the waiver before your skin treatment.
Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please read the following waiver carefully:
I understand that the skin treatment involves certain risks and I voluntarily assume all risks associated with the procedure. I release the clinic and its staff from any liability resulting from the treatment.
Signature
Submit
Should be Empty: