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Facial Intake & Consent Form

Please complete the form prior to first appointment

Skin Type Required
Skin Concerns Required

Consent & Acknowledgment 

I understand that:

 • Facial treatments are non-medical, cosmetic procedures intended to improve skin condition.

 • Results vary depending on skin type, condition, and aftercare; multiple treatments may be needed.

 • Temporary redness, irritation, or breakouts may occur.

 • I must disclose all health conditions, medications, and recent treatments for my safety.

 • My provider may refuse or modify treatment if it is not safe for me.

 • I will follow all aftercare instructions provided.

Appointments must be rescheduled or canceled at least 48 hours in advance. I agree that if I fail to do so, a $50 fee will be charged.

Release: I release Atrosa Med Spa and its staff from liability for any unintentional or adverse skin reactions, including those due to undisclosed conditions or product use.”

 

I have read and agree to the Consent & Release Statement.”

Thanks for submitting!

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