Beauty Bar | Wappingers Falls, NY | Mojo Modern Beauty Bar

CONSENT FORMS

Rezenerate Client Consent Form

Consent 1

DESCRIPTION OF THE FACIAL: The Rezenerate Facial System allows the targeted products/serums chosen by you and your skin care professional to reach maximum efficacy! The intended result is typically smoother, firmer and younger looking skin, but any number of results can be achieved depending upon the chosen serum/products used. Rezenerate Facials are performed in a safe and precise manner with the use of sterile Rezenerate components. (All serum/products should be discussed separately with your skin care professional.)

Consent 2

POTENTIAL SIDE EFFECTS: I recognize there are no guaranteed results and that results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require further facials to obtain the expected results at an additional cost. After the Facial, in rare cases, the skin will be pink and flushed in appearance. You may also experience skin tightness and mild sensitivity to touch or sweating on the facial area.

Consent 3

I understand that results will vary between individuals. I understand that although I may see a change after my first Rezenerate Facial; I may require a series of Rezenerate Facials to obtain my desired outcome. I understand that the Rezenerate Facial is a cosmetic treatment, not a medical procedure.

Consent 4

The Rezenerate Facial and any potential contraindications or side effects have been explained to me to my complete satisfaction.

Consent 5

I am advised that though good results are expected, the possibility and nature of complications cannot be accurately anticipated and that, therefore, there can be no guarantee as expressed or implied either as to the success, or any other result of the Rezenerate Facial, and I hold Rezenerate and my skin care professional harmless for any undesired effect.

Consent 6

I state that I have read (or it has been read to me) and I understand this consent and I understand the information contained in it. I have had the opportunity to ask any questions about the Rezenerate Facial including risks or alternatives and acknowledge that all my questions about the facial have been answered in a satisfactory manner.

By initialing below and checking all the boxes above, I agree to these terms and the answers are valid for all Rezenerate facials I receive

First Name

Last Name

Date

Rezenerate Client Consent Form

Consent 1

I give my consent for dermaplaning to be performed by Mojo Modern Beauty

New Field:

Dermaplaning is a physical/mechanical form of exfoliation using a specialized dermaplaning blade for the removal of built up dead skin cells and vellous hair. Following treatment skin will be smoother, softer and better able to absorb the active ingredients in treatment and home care products. I understand this treatment involves the use of the sterile, surgical blade to remove dead skin cells and vellous hair. As with the use of any sharp instrument, there is the possibility of nicks or cuts. I understand there are contraindications to this treatment, including but not limited to, diabetes (not controlled by diet or medication), cancer, active acne, bleeding disorders, the inability for blood to coagulate or the development of keloids following injury. Certain medications including blood thinners, higher dosages of Aspirin, and Accutane are contraindicated for this treatment due to the possibility of delayed clotting from a nick or cut. I certify that I am not taking any of the above medications or experiencing any of the above conditions. While every precaution will be taken to avoid nicks, cuts and scratches, I understand the risks and consent to treatment today.

First Name

Last Name

Date

Medical Intake Form

Rezenerate Client Consent Form

Rezenerate Client Consent Form