Intimate Bleaching Consent

I have voluntarily elected to undergo Intimate Bleaching. The nature and purpose of this treatment has been explained to me, along with the risks and hazards involved, by The Spa Society.  Although it is impossible to list every potential outcome, I have been informed of possible benefits, risk, and complications. I also recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle and that there is a possibility I may require further treatments to obtain the expected results at an additional cost. If applicable, I have read and understand post-treatment home care instructions. I understand how important it is to follow all instructions given to me for post-treatment care. I will consult the esthetician immediately with additional questions or concerns regarding my treatment, home products, or post-treatment care. I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I do not hold THE SPA SOCIETY or the esthetician, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of the procedure, which may be affected by the procedure(s) being performed.
I hereby consent to and authorize THE SPA SOCIETY for the above procedure: