Watercourse Way

Notice for Facials

WATERCOURSE WAY NOTICE/WARNING FACIAL TREATMENTS

Prior to receiving the facial treatment, I certify, understand and acknowledge the following:

  1. I have fully and thoroughly revealed to my esthetician any and all medical or physical conditions that may have an impact on this procedure or my recovery from this procedure or that may be impacted by this procedure, including, but not limited to, pregnancy and/or lactation, recent facial surgeries, allergies, tendency for cold sores or fever blisters, and the use of Retin A, Accutane or hormones within the past year.
  2. During the treatment there may be some degree of mild discomfort, including stinging or burning.
  3. There may be temporary side-effects following the treatment, including, but not limited to, stinging, tightness, mild swelling, redness, peeling or scabbing, infection, cold sores with prior history of herpes, or possible acne-like lesions. I understand that I also may experience temporary or permanent pigment changes.
  4. No guarantees have been made to me as to the results of this treatment. The results of this treatment may be impacted by many variables, including such things as my age, the condition of my skin, sun damage to my skin, smoking, climate, post-peel care, or picking the skin.
  5. For best results and to minimize the risk of side effects or complications, I must follow all prescribed post-treatment directions and care.
  6. I should not apply anything to the treated area for three hours after treatment. I may start home-care products 24 to 48 hours after the treatment.
  7. I should avoid direct sun exposure and artificial tanning activities and that I should not have another treatment until at least 48 hours after this procedure.
  8. Although complications are very rare, sometimes they do occur and that prompt medical treatment is necessary.
  9. This treatment has been explained to me and I have been able to ask questions about the treatment and the risks of having the treatment. I have a clear understanding of possible risks, side effects and complications from the treatment.
  10. There may be risks and side effects, both short and long term, which are not known at this time and that may not be anticipated or predicted.
  11. I have chosen to undergo voluntarily this treatment after considering the above warnings and issues and the alternatives to this treatment, including non-treatment and other procedures.

I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ABOVE NOTICES AND AGREE TO ABIDE BY WATERCOURSE WAY’S POLICIES. I UNDERSTAND AND AGREE THAT I MUST SIGN THE WATERCOURSE WAY RELEASE AND WAIVER OF LIABILITY BEFORE BEING PERMITTED TO RECEIVE A FACIAL TREATMENT.




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Signature Certificate
Document name: Notice for Facials
Unique Document ID: 02352f7160183457c93c745ad4ad67661eb17029

Timestamp Audit
2016-05-24 11:10:30 +00 Notice for Facials Uploaded by Watercourse Way – info@watercourseway.com IP 103.235.198.9