Microdermabrasion Release Form

Client Information

Full Name Date of Birth Phone Number Email

Medical History

Allergies Skin Conditions Current Medications

Procedures & Risks

I understand that microdermabrasion is a skin-freshening technique that helps repair facial skin by removing the topmost layer by gently exfoliating the skin. I understand that risks may include temporary irritation, redness, and sensitivity.

I agree to follow pre- and post-treatment instructions and to inform the technician of any changes to my medical history prior to each session.

Signature

Client Signature Date