Facial Treatment Consent Form



I understand that my facial treatment may include clinical-strength products, enzymes, acid peels, dermabrasion, dermaplaning, extractions, microcurrent, galvanic, waxing, high frequency, ultrasonic and other treatment modalities as necessary.


I understand that this is a cosmetic treatment and that no medical claims are expressed or implied. I understand that to achieve maximal results, I may need more than one treatment and I need to follow the recommended home maintenance protocol.


I understand that there are no guarantees as to the result of this treatment, due to many variables such as age, conditions of the skin, sun damage, smoking and climate. I may or may not experience actual “peeling” with this procedure as each case is individual.


I understand that there may be some degree of discomfort, i.e. stinging, “pin-pricking” sensation, hotness or tightness. I will keep my esthetician informed during the service.


I agree to refrain from tanning or excessive sun exposure on the day of my treatment. I understand that direct sun exposure is prohibited while I am undergoing treatment and that the use of sun block protection with a minimum SPF 15 is mandatory.


I will reveal any medical conditions that may effect the treatment such as pregnancy, cold sore tendencies, allergies, recent facial peels, laser or surgery, any types of contraindicated medications such as Accutane, hormone replacement therapy or use of Retin-A. Contraindicated medications should be discontinued five days prior to the treatment with exception of Accutane which must be discontinued for six months prior.



Prior to receiving treatment, I have been candid in revealing any condition that may have an effect on this procedure as outlined. I will also inform SOS WAX and Skincare of any changes in my medical history, current medications and/or any changes relevant to this procedure prior to any future treatments.


I have read, understand and I consent to the terms of this agreement. By signing below, I assume any risk, harm or injury which may occur as a result from facial treatment services and I give my permission to my esthetician at SOS WAX and Skincare to perform the services. I will hold the esthetician and SOS WAX and Skincare harmless of any liability and waive any claims that may result from the services.

Who is receiving the Service?

Adult (You)  Minor

Signee Information

If so, please list all (including over the counter drugs / herbal supplements)

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By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.