Acne Treatment Consent Acne Treatment Consent Name First Last PhoneEmail Date An acne treatment may consist of surface cleansing, mild chemical peels or steam and exfoliation. application of antibacterial serums, corrective serums and extractions. Treatments take approximately 20 to 45 minutes to complete and are designed to balance, hydrate, clear acne impactions and prepare the skin for the home care regimen. Implements and equipment used in this facility are disposable or properly sterilized according to the State Board regulations.IMPORTANT PLEASE READ CAREFULLY:* I have not been exposed to excessive sun and my skin does not feel sensitive or irritated in any way. I have not had any other chemical peel of any kind, within 14 days of this treatment. I have not had any facial waxing, within seven days of this treatment. I have informed the clinic of any use of oral or topical medications I may be using including Retinoids.Retin-A, Renova, Avita, Differin, Tazorac or Accutaine. I understand that controlling acne/problem skin is best achieved through a series of recommended treatments and compliance to the home care product program recommended by a Certified Licensed Acne Specialist. I understand that I will probably not experience much visible peeling, flaking, discoloration or irritation following this procedure if I follow my homecare instructions carefully. WARNING: PLEASE READ CAREFULLY:* Avoid direct sunlight or tanning booths for at least three days following a treatment. Use of sunblock protection of at least a SPF 30 is necessary following all treatments. Do not pick your skin following a treatment. PRODUCT RETURN GUIDELINES: PLEASE READ CAREFULLY:* Face Reality Skin Care products are clinical strength active formulas designed to treat problem skin conditions. Tingling sensations are normal with product application but should not be painful. If you are experiencing stinging and irritation with any product, stop using the product and call, text or email your esthetician for further instruction. Products may be returned within 7 days for a full refund, provided they have not been opened and/or used. If products have been opened or used it is mandatory to speak with your esthetician for authorization to return the product. RESCHEDULING GUIDELINES AND LATE POLICY: PLEASE READ CAREFULLY:* A 24 hour rescheduling notice is required. We realize emergencies happen and will be considered, but reserve the right to charge a $35.00 fee for missed appointments without a 24 hour notice. Late fees will be billed accordingly. PHOTOGRAPHS:* I consent to photographs taken of my face to be used for monitoring treatment progress and for possible marketing purposes. AGREEMENT:* I hereby agree to all of the above and agree to have this treatment be performed on me. I further agree to follow all post treament care instructions as I am directed. SignaturePhoneThis field is for validation purposes and should be left unchanged.