In order to provide you with the most appropriate treatment, we need you to complete the following questionnaire. All Information is confidential.
I certify that preceding medical, personal, and skin history statements are true and correct. I am aware that it is my responsibility to inform the technician of my current medical and health conditions and to update this information at subsequent visits. A current history is essential for the provider to execute appropriate treatment procedures. I have signed the consent form for this procedure. I had the opportunity to ask questions prior to the treatment. I accept arbitration as a means of resolution for practice liability.
High Frequency should not be used on clients with the following conditions or devices
Body piercings from the waist up; the client should avoid any contact with metal such as chair arms, jewelry, and metal Bobby pins during the treatment; a burn may occur if such contact is made
Adhere to the following guidelines
To avoid being burned, the client should avoid contact with metal during electrical machine treatments
Clients should remove all jewelry and piercings prior to the treatment
The technician should ground their finger on the electrode prior to applying it to the group the client and prior to removing it from the client
The electrode should always be continuously moving
Electrodes should be gently removed from the handpiece to avoid snapping the electrode
To avoid potential health complications, do not use Galvanic Current on clients with the following conditions:
Apprehension about the use of electrical appliances
Vacuum machine should not be used on Couperose skin with distended or dilated capillaries or an open lesions to avoid harming the client skin, do not use suction or inflamed, rosacea, or couperose skin.
Running Late: We understand things happen, if you are running late we will still take you in, but to be fair to all of our clients that showed up on time we will have to cut your service short to stay on schedule for everyone. You will also be responsible for the total cost of your booked appointment that you were late for.
All Appointment Cancellations are to be cancelled no less that 12 hours before appointment start time. Every infraction that is cancelled after the 12 hour period there will be a 40% of the scheduled service(s) fee. If you no call/no show you will be held liable for 80% of the services you were scheduled to receive and the Credit Card you have on file with us will be charged. By you making this appointment you are accepting and agreeing to all of our terms.
By clicking/tapping/touching/selecting or otherwise interacting with the "Submit" button below, you are consenting to signing this Document electronically. You agree your electronic signature ("E-Signature") is the legal equivalent of your manual signature on this Document. You consent to be legally bound by this Document's agreement(s), acknowledgement(s), policy(ies), disclosure(s), consent term(s) and condition(s). You consent to be legally bound by Waiver Master's policies, terms and conditions available at waivermaster.com/terms.html and waivermaster.com/privacy.html . You agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature. You may request a paper version of an electronic record by writing to us. We reserve the right to charge a reasonable fee for the production and mailing of a paper version of the record. Your current valid email is required for all communications.