By Signing Below, I agree:

I have completed this form to the best of my ability and knowledge and all information is true and correct. I understand I must wait 48 hours after a Chemotherapy infusion prior to having a skin care treatment. I agree to inform the technician of any changes to the above information prior to treatment. I confirm that I do not have any condition(s) that make the requested unsuitable for me personally. I will inform the technician immediately of any discomfort I experience at any time during the treatment.

I understand that certain treatments, products or chemicals may have unpredictable interactions with my skin, cause discomfort or reactions including but not limited to derma planing, serum infusions and chemical based peels. I also understand that due to my medical history, cancer therapy and medications; some skin conditions may require more than one treatment to achieve desired results. I acknowledge that to achieve maximum results I will need to discontinue the use of home care products containing ingredients that are too strong, aggressive or dry the skin. 

I agree to waive ALL liability toward my technician and SEAVANA Skin for any injury or damages incurred due to treatments. I understand that signing below and submitting this form I am digitally signing this agreement and all accept the information contained within.