Please answer the following questions so that we have a better understanding of your general health and lifestyle. This will aid your Skin Care Professional in a more accurate analysis and/or the possible contributing factors to progress and improvement of your skin. Thank You!

Medical history

  • I understand that taking the treatment course is my choice and that I am free to withdraw at any time, without giving any reason.
  • I was told the possible side effects of the treatment include: local pain, skin redness (erythema), swelling (edema), damage to the natural skin texture (crust, blister, and burn), fragile skin and bruising. Although these effects are rare and expected to be temporary, any adverse reaction should be reported immediately.
  • I understand that not everyone is a candidate for this treatment and results may vary.
  • I confirm that I have read and understand the above information and will undergo the treatment out of my own free will/
  • I believe I have adequate knowledge upon which to base an informed consent.
  • I understand that all payments are due at time of service. I understand that I am responsible for all charges. Money for prepaid packages is non-refundable, however, credit for services yet to be delivered may be applied to receiving any other services or products offered at My Vida Spa. Cancellation of appointments without rescheduling must be done 24 hours prior to the appointment to avoid treatment fee charges.
  • I affirm that all information provided above is correct to the best of my knowledge.