Facials

Informed Consent & Release of Liability

Name

First Name

Last Name

Informed Consent:

I understand that if I have topical allergies or sensitivities, Rich Earth Organic Skin Care Studio makes every effort to eliminate any specific ingredient as well as all related ingredients that I believe may be problematic from my facial and recommended skin care products. However, as many skin care products have proprietary, highly complex formulations, realistically this cannot be absolutely guaranteed. Rich Earth Organic Skin Care Studio and its practitioners cannot be held responsible for ensuring complete avoidance of any particular ingredient(s) in any facial or skin care product, nor can they be held responsible for any unexpected reaction to an unknown allergen or for any other unexpected issue from unknowable causes. I understand if I have any active, communicable, untreated, topical infections or conditions on areas to be worked on (such as cold sores, pink eye, impetigo, ring worm, warts, etc.,) these conditions must be healed (no longer actively infectious or spreadable) before receiving a facial. I understand that if I am prone to cold sores, it is recommended that I use cold sore medication several days prior to my facial and several days after. I understand that if I am pregnant, have a pacemaker (or any implanted device), have a cardiac condition, have epilepsy or have cancer, I cannot receive ultrasonic treatments in my facial, and I will inform my Rich Earth Organic Skin Care practitioner of this fact.

Release of Liability:

By signing this agreement, I am confirming I understand there may be some inherent risks associated with receiving facials/treatments and using skin care products, including those provided by Rich Earth Organic Skin Care Studio. I acknowledge and agree I am responsible for my own health; that Rich Earth Organic Skin Care Studio and Rich Earth Organic Skin Care Studio practitioners cannot be expected to diagnose and/or treat individual health problems. By voluntarily choosing to receive facials/treatments and/or use recommended skin care products, I warrant that to the best of my knowledge, I have no condition that is contraindicated for receiving such facials/treatments and using such skin care products. I understand it can be impossible to guarantee or predict a specific aesthetic outcome, so no such guarantee has been made to me. I also understand it can be impossible to predict who may have an unexpected, adverse reaction to a facial/treatment or skin care product, and as such, I acknowledge that I am choosing to receive facials/treatments and to use skin care products of my own free will, with the complete understanding that I cannot hold Rich Earth Organic Skin Care Studio responsible for any inherent risk or unexpected adverse reaction that could occur. In light of the foregoing, I hereby release Rich Earth Organic Skin Care Studio and its practitioners and waive any and all claims, liabilities, or damages for personal injuries that I may experience directly or indirectly from receiving facials/treatments or using skin care products provided by Rich Earth Organic Skin Care Studio.

Date

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