Previous adverse reaction to Aspirin? *

Previous adverse reaction to Hydrocortisone? *

Previous adverse reaction to Lidocaine? *

Have you been treated with a neuromodulator (Botox, Dysport, Xeomin, etc) before? *

Have you been treated with dermal fillers before? *

I acknowledge that I have not used Accutane or any medication of the same purpose during the last 12 months. *

I acknowledge that if I've ever had a cold sore or fever blister, I should consult with my physician or pharmacist for a pre-use medication to help avoid a possible outbreak. That medication should be used each day for two days before, same day, and two days after any laser facial treatment. *

I acknowledge that there is no guarantee that dark discoloration of skin will be reduced or faded. Pigmentation may improve or darken with successive treatments. I acknowledge the need for a proper skin care home regimen. *

I acknowledge that my skin might experience temporary irritation, tightness, redness or slight swelling, which usually dissipates within 72 hours depending on skin sensitivity. *

I acknowledge that if I fail to use a minimum sunblock (SPF 30), I am more susceptible to sunburn, skin damage & hyperpigmentation. *

I acknowledge that this treatment is strictly an elective cosmetic procedure and that no medical claims have been expressed or implied. *

I acknowledge that I should avoid use of acid products for 1 week prior, and 1 week following any light based treatments. *

I acknowledge that I should avoid the use of Retin-A type products for a period of time recommended by my medical or skincare professional during and following the treatment. *

I acknowledge that I am not pregnant or lactating. *

I acknowledge that I have answered all questions truthfully and completely. *

I acknowledge that Flawless Laser & Body Sculpting has a 24hr cancellation policy. Cancellations with less than 24 hours notice will subject to a fee of $50 per hour for every hour of treatment time that your procedure was scheduled to require. *

I hereby expressly waive and release any and all claims which I have or may in the future have against Flawless Laser And Body Sculpting Inc (including their contractors, affiliates, and their respective directors, officers, employees, agents, representatives, shareholders, successors and assigns) (collectively, "Releasees"), arising out of or attributable to receiving the procedure described herein, due to any cause whatsoever, including without limitation the negligence of any Releasee, breach of contract, or breach of any statutory or other duty of care owing under occupiers liability legislation or otherwise. I covenant not to make or bring any such claim against any Releasee, and forever release and discharge all Releasees from liability under such claims. *