Acknowledgement Of Information

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If under the age of 18 years, Parent / Legal Guardian Consent to treatment is required.

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I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it  supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. The treatments I receive here are voluntary  and I release this institution and/or skin care professional from liability and assume full responsibility thereof.

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I understand that my data will be strictly confidential. Epitome Face Body and Electrology does not sell, share, or resell information.  I confirm that all information in this form is true and accurate. I confirm that if I hold some important information and complications happened, Epitome Face Body and Electrology and staff, will not be liable. I release Epitome Face Body and Electrology and staff and hold harmless against any claims, expenses, damages, and liabilities.