Client Informed Consent for Treatment

Although every precaution will be taken to ensure your safety and well-being before, during, and after your treatment/procedure, please be aware of the following information and possible risks and indicate that you fully understand what to expect. Please check:

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Although every precaution will be taken to ensure your safety and well-being before, during, and after your services, please be aware of the following information and possible risks and indicate that you fully understand what to expect.
  • I voluntarily agree to undergo the treatment(s) after the nature and purpose of the treatment(s) has been explained to me, along with the benefits, risks and any complications involved. I understand that it is possible I may not be a candidate for the service(s) I have selected. In the event the esthetician does not recommend performing the service(s) I selected, I agree to work with her to discuss other treatment options appropriate for my skin type.
  • I understand that it is imperative to my health and safety that I disclose all the information requested in the Client Health History form. I have cited all conditions and circumstances regarding my health, allergies, and medications, supplements, or prescriptions being taken (orally and/or topically), and any past reactions to products or medications.
  • I understand that no specific guarantees of the results can or have been made and that there is the possibility I may require additional treatments to obtain the expected results at an additional cost.
  • I have discussed, read, or been given a copy of the service description, pre-treatment and post treatment care instructions. I understand the importance of following all instructions given to me and that I may refer to www.olyskinandwax.com should I need to revisit the information provided before, or at the time of the service. In the event that I have additional questions or imminent concerns, I will consult the esthetician immediately. I understand that if I choose to consult a physician, I do so at my own expense.
  • I consent to privacy protected, unrecognizable “before-and-after” photos for the purpose of documentation, potential advertising, and promotional purposes.

I agree to the above precautions, acknowledge the information, and understand that if I have any concerns, I will address these with the esthetician. I give permission to the esthetician to perform the treatments/procedures requested, and will hold her harmless and nameless from any liability that may result from the treatments/procedures. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I have read and fully understand the above paragraphs and I have been provided sufficient resources and opportunity to discuss and to have any questions answered. I understand the procedures and accept the risks. I do not hold the esthetician, whose signature appears below, responsible for any of my conditions that were present but not disclosed at the time of this procedure that may be affected by the treatment performed. This agreement will remain in effect for this procedure and for all future procedures conducted by my esthetician.

I understand that if I have any concerns, I will address these with my esthetician. I give permission my esthetician, Melissa Williams of Oly Skin & Wax, to perform the above treatment/procedure we have discussed and will hold her harmless and nameless from any liability that may result from this treatment/procedure. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read and fully understand the above paragraphs and that I have been provided sufficient opportunity for discussion and to have any questions answered. I understand the procedure and accept the risks. I do not hold Melissa Williams, my esthetician, whose signature appears below, responsible for any of my conditions that were present but not disclosed at the time of this procedure that may be affected by the treatment performed today.

Clear Signature
Esthetician Signature: (To be Signed at the time of appointment) ________________________________
Date: (To be dated at the time of appointment) ________________________________