REMOVAL
prep

 

Please submit the following 2 forms 24 hours before arriving for your first removal session.

 

PART 01

client information and medical history


Basic Information
Name *
Name
Date of Birth *
Date of Birth
Phone *
Phone
Medical Information
Conditions
Check All That Apply
If you checked any of the above, please explain further:
Please list any medical conditions or issues not addressed above:
Which of the following best describes your skin type? Please select one.
CLIENT STATEMENT
Please check next to the statement after you clearly understand each.
1 *
2 *
3 *
4 *
5 *
6
7
8 *
9 *
10 *
11 *
12 *
13 *
14 *
15 *
Digital Signature *
Digital Signature
Today's Date *
Today's Date
*
 

Part 02

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT


Agreement *
information *
INFORMED CONSENT *
Assumption of Risk *
RELEASE AND WAIVER OF LIABILITY *
INDEMNITY *
CHOICE OF LAWS/SEVERABILITY *
I HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND ITS TERMS. I AM AWARE THAT THIS AGREEMENT INCLUDES A RELEASE AND WAIVER OF LIABILITY, AN ASSUMPTION OF RISK, AND AN AGREEMENT TO INDEMNIFY RELEASEES. I UNDERSTAND I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS AGREEMENT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Digital Signature *
Digital Signature
Today's Date *
Today's Date
*