My signature acknowledges that I have read and agree to receive the treatment or series of treatments listed above and that I will adhere to all of the aforementioned statements that I have initialed. I fully understand the risk and side effects associated with the treatment. I freely assume the risks and release the provider and the Waxer of all liability.
I hereby consent to and authorize Monica Holmes, to perform the following procedure:
I have voluntarily elected to undergo this treatment/procedure after the nature and purpose of this treatment has been explained to me.
I understand and acknowledge that there are risks involved with the treatment I will be receiving. Although it is impossible to list every potential risk and complication, I have been informed of possible benefits, risks, and complications, and I have had the opportunity to ask questions regarding these risks and other possible complications.
I also recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle.
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. If I may have additional questions or concerns regarding my treatment of suggested home product post-treatment care, I will consult the Waxer immediately.
I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically.
I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. I agree I will assume the risk and full responsibility for any and all injuries, losses, side effects, or damages which might occur to me while I am undergoing
this procedure.
I do not hold the Waxer, whose signature appears below, 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 agree that in no event, and at no time during the Term of this Agreement or at any time, thereafter, shall I disparage, denigrate, slander, libel or otherwise defame the business, services, properties or assets, or employees, personnel, agents, or representatives.
