I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and
that it supersedes any previous verbal or written disclosures. I understand that withholding information or provid-
ing misinformation may result in contraindications and/or irritation to the skin from treatments received. The treat-
ments I receive here are voluntary and I release this institution and/or skin care professional from liability and
assume full responsibility thereof.