By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it.<
Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary. (“I”, “me”, “my”), authorize a designated practitioner of Georgetown Allure (or “Esthetician) to perform treatment (or “procedure”) on the following areas of my body: Face, neck, and décolletage. The purpose of the procedure is to beautify the skin of the face and neck area. The specific benefits of the procedure have been explained to me by a member of the Georgetown Allure team.
I recognize there are no guaranteed results and that my individual results are dependent upon my age, skin condition, and lifestyle. The team member has also informed me of the possible risks and complications associated with the procedure. I understand these risks and I have been given the opportunity to have all my questions answered to my satisfaction. I accept these risks and choose to undergo the procedure. I have read and understood the post-treatment care. In the event that I may have additional questions or concerns regarding my procedure or suggested home post-treatment care, I will consult Georgetown Allure immediately. I have given an accurate account of my medical history and current health. Our facial rooms may be monitored or recorded for quality assurances purposes.
Your continued participation in this treatment serves as express consent to be monitored or recorded. I have disclosed all prescription, over-the-counter, and other drug use and all known allergies. I understand that the procedure involves payment and the fee structure has been explained to me. I have read and fully understand this consent and waiver form before signing it. I understand the procedure and accept the risks and all my questions have been answered to my satisfaction. I also consent to be photographed and/or videoed on this date by the assigned photographer while attending the Georgetown Allure Appreciation event. I further authorize the photographs and/ or videos be published for any purpose and in any form for Georgetown Allure.
