Home Treatment Consent

I am aware Home Treatment offers higher concentration of pharmaceutical grade ingredients. Due to their potent nature and its effect on individual skin conditions and needs, it is important to follow the instructions given by your Cosmetic Specialist for a safe and effective result. Those instructions need to be reviewed from time to time, season to season, year to year, based on individual needs and reactions to treatments.

Please read each of the following statements and indicate by (check mark) that you have read and understand each statement.

Name

First Name

Last Name

Email

I understand it is my choice whether or not to use Home Treatments.

Yes

I understand the side effects of Home Treatment may include redness, tightness, peeling, flaking, swelling, bumps, hyperpigmentation, sun sensitivity and other possible reactions.

Yes

I understand it is my own decision whether or not to use Home Treatment during pregnancy/ breastfeeding or any health related concerns.

Yes

I understand that to achieve optimal results I need to see a Dermatologist.

Yes

I understand all Home Treatment are NON-REFUNDABLE and NON-EXCHANGABLE.

Yes

By Clicking Accept constitutes my acknowledgment that I have read and understand the information provided in this form.

Home Treatment Consent

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