Consent Form

Health Assessment

Selfcare Esthetics Consent for Facial Treatment

I understand that I may have some discomfort, redness or swelling, itching or irritation, skin peeling or flaking after a facial treatment. If I experience any pain or discomfort during the session, I will immediately inform the esthetician so that the products and/or technique may be adjusted to my level of comfort. I further understand that facial should not be construed as a substitute for medical examination, diagnosis, or treatment. I understand that estheticians are not qualified to perform, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such. Because certain treatments should not be performed under certain medical conditions, I understand that the Licensed Esthetician reserves the right to refuse to perform treatments on anyone whom he/she deems to have a condition for which facial treatments are contraindicated. I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the esthetician updated as to any changes in my medical profile during the session and understand that there shall be no liability on the esthetician’s part should I fail to do so.

It is my decision to have this treatment and I certify that I have read and have full understanding of the above consent. I have been given ample opportunity for discussion and all of my questions have been answered to my satisfaction. I hereby consent to the facial treatment procedure. This constitutes the full disclosure and supersedes any previous verbal or written disclosures. Selfcare Esthetics or the Licensed Esthetician is not responsible for any injury or allergic reaction(s) or any skin abrasions as a result of the services performed on me.