Consent Forms

First Name

Last Name

Phone

Email Address

Which consent form do you need to complete? Which consent form do you need to complete?Facial Services Consent (New Client)SilkPeel DermalInfusion Consent

Check the boxes below to indicate agreement and consent to the following statements: Check the boxes below to indicate agreement and consent to the following statements: I understand that individual results may vary based on skin type, frequency of the services and other factors not controlled by Janet St Paul Studio. I have been advised of the esthetics service I am about to receive. I will discuss pre—existing conditions and associated treatment and medication with my technician. I acknowledge my obligation and promise to follow the written and spoken instructions covering my pre and post treatment skin care regimen. I acknowledge that I have read the treatment information and understand it. I have also fully disclosed all necessary information before receiving the treatment. Additionally, I have been informed of all possible risks and would like to receive the treatment.

Check the boxes below to indicate agreement and consent to the following statements: Check the boxes below to indicate agreement and consent to the following statements: I understand that the individual results of my services may vary. I am not allergic to aspirin. I have stopped any use of retinols 48 hours prior to my SilkPeel DermalInfusion service. It has been more than 2—3 weeks since I have received any cosmetic injectables which include neuro modulators, filler or p.o.d. threads. I have taken Valtrex if its been recommended by my physician. This procedure has been explained to me, and any questions I have regarding this procedure have been explained to my satisfaction. I also understand the importance of staying out of the sun for 5—7 days after my treatment. I acknowledge my obligation and promise to follow the written and spoken instructions covering my pre and post treatment skin care regimen.

Please include any additional notes or details for your Esthetician: