HydraFacial

Name

First Name

Last Name

Informed Consent:

I understand that if I am allergic to shellfish (glucosamine), honey (bee products) or aspirin (willow bark extract or salicylic acid), have severe rosacea, have significant telangiectasia (dilated capillaries), am taking Accutane (now or within the past six months), have received cosmetic facial injections less than two weeks ago, have red or raised bumps or other unidentifiable skin issues, have an autoimmune disease, or am pregnant or nursing, I will inform my Rich Earth Organic Skin Care Practitioner that I should not receive a HydraFacial, and will opt to forgo this facial/treatment or opt for a facial/treatment that does not present known contraindications instead. I understand that if I am prone to cold sores, it is recommended that I use cold sore medication several days prior to my HydraFacial and several days after.

Release of Liability:

By signing this agreement, I am confirming I understand there may be some inherent risk 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 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 of 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.

Signature - by typing your name here, you are acknowledging that you have read and understand the information presented to you.

Date

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