Glo Skin Informed Consent Form

I certify that I am a competent adult of at least 18 years of age

I certify that I am a minor under the age of 18 and understand that the consent of my parent/legal guardian will also be required before treatment.

I have been given the Client Information Form and have

read and completed the questions thoroughly.*

I acknowledge there may be some degree of discomfort

during application. I will notice a warm sensation and the

skin may tingle or sting and I may feel pin pricking, heat

(burn) or tightness.*

I am willing to forego a patch test but understand there

could be an allergic reaction.

I have had a patch test and it is negative. In the event of

any complications, I will immediately contact the Skincare Professional who performed the treatment.*

I acknowledge there are no guarantees as to the results

of this treatment, due to many variables, such as: age,

condition of skin, sun damage, smoking, hormones,

lifestyle, climate, etc. I understand I may or may not

actually peel, and that each case is individual.*

I have been advised that my treatment is a non-invasive,

light exfoliation consisting singly, or a combination of

Salicylic Acid, Lactic Acid, Glycolic Acid, Resorcinol,

Trichloroacetic Acid, Retinoic Acid or Enzymes.*

I acknowledge that to achieve maximum results, I may

need several treatments.*

I understand that the use of the above ingredients

stimulates the skin to generate new cells. It does not

replace a deep chemical peel, laser resurfacing or plastic

surgery.*

I acknowledge that I will avoid direct sun exposure

following this procedure and will apply sunscreen daily.*

I am aware and acknowledge there is a rare possibility of

an allergic reaction. I have discussed with my Skincare

Professional any such reactions and understand them.*

My Skincare Professional has answered any questions

I have regarding my post care. I acknowledge my

obligations to closely follow the post treatment

instructions and visit my Skincare Professional for a post

treatment follow-up as specified.*

I consent to the chemical exfoliation treatment discussed with my Skincare Professional and fully understand all risks associated.*