I have read the above information. If I have any concerns, I will address these with my skin care therapist. I give permission to my
therapist to perform the tinting procedure we have discussed, and will hold him/her and his/her staff harmless from any liability
that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription
drugs, or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize
or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my
treatment, I will consult the esthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous
verbal or written disclosures. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient
opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the
esthetician, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time
of this skin care procedure, which may be affected by the treatment performed today.