Treatment Check-in form

I understand this is an elective procedure and I hereby voluntarily consent to the treatment. The procedure has been fully explained to me. I also understand that any treatment performed is between me and the Service Provider who is treating me and I will direct all post-procedure questions or concerns to the treating Service Provider. I have read the above and understand it. My questions have been answered satisfactorily. I accept the risks and complications of the procedure and I understand that no guarantees are implied as to the outcome of the procedure. I also certify that if I have any changes in my medical history I will notify the Service Provider who treated me immediately.

I have read and understand the post-treatment home care instructions. I understand how important it is to follow all instructions given to me for post-treatment care. In the event that I may have additional questions or concerns regarding treatment or suggested home product/post-treatment care, I will consult the Specialist immediately.

I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies, prescription drugs or products I am currently ingesting or using topically. I have read and fully understand this agreement and all information detailed above and I consent to the terms of this agreement. I do not hold Specialist, sonia Felix, or any other specialist, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today. I also release any liability that may arise from this procedure.

I also state that I read and write in English.