Name *

First Name

Last Name

Phone

(###)

###

####

Which Treatment are you receiving today? *

Basic Facial

Laser Hair Removal

Waxing

Electrolysis

Hydrofacial

Apolo Duet Facial

RF Microneedling

Brow lash or tint

Other

I have understood the information provided verbally regarding the treatment. I have had the opportunity to ask questions, and my questions have been answered satisfactorily. I understand the risks, benefits, and alternative options associated with the treatment, and I consent to undergo the treatment. *

I consent and Agree

I consent and Agree