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Client treatment consent

Client Treatment Consent & Release

Please initial each statement.

                I acknowledge that beauty treatments, the practice of skin care, including, but not limited to, laser hair removal, tattoo removal, brown spot removal, permanent cosmetics, body treatments, microdermabrasion, chemical peels, dermaplaning, skin needling, Botox, Collagen, Dermal Fillers, Sclerotherapy, and other various beauty procedures is not an exact science and no specific guarantees can or have been made concerning the outcome.

                I understand that some clients experience more change and improvement than others. In virtually all cases, multiple treatments are required in order to produce noticeable results.

                I understand and agree to assume the following risks and hazards which may occur in connection with any particular treatment including but not limited to: unsatisfactory results, soreness, poor healing, discomfort, prolonged erythema or edema, redness, blistering, visible flaking or peeling, abrasion, nerve damage, scarring, infection, change in skin pigmentation, allergic reaction, muscle damage, and increased hair growth.

                I understand that even though precautions may be taken in my treatment, not all risks can be known in advance.

                I understand that risks of complications are higher for patients with darker skin types.

                I have fully disclosed in my client forms any medications, previous complications, or current conditions that may affect my treatment: such as, but not limited to,  pregnancy or nursing, neurological diseases, allergies, history of cold sores/fever blisters, use of Accutane in the past year, and other various medical contraindications. 

                I have read and understand the possible side effects from any given treatment. 

                Given the above, I understand that response to treatment varies on an individual basis and that specific results are not guaranteed. Therefore, in consideration for any treatment received, I agree to unconditionally defend, hold harmless and release from any and all liability the company and the individual that provided my treatment, the insured, and any additional insureds, as well as any officers, directors, or employees of the above companies for any condition or result, known or unknown, that my arise as a consequence of any treatment that I receive.

                I agree that this constitutes full disclosure and that It supersedes any previous verbal and written disclosures. My signature indicates that I am consenting to receive treatment, having read and understood the information presented above.

                I have fully read this consent form and understand the information provided to me regarding the proposed procedures, and I have had all questions and concerns answered to my satisfaction.

                I understand that I release Southern Laser Med Spa and it associates, the Medical Supervisor, the technician performing services, and Southern Laser Med Spa employees involved in my treatment from any liability associated with complications from procedures.

Thanks for submitting! We now have your submitted signed form.

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