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Love Yourself
Home
Our Story
Contact
Contact
Bookings
Appointments
Consent Forms
Pre + Post Care
Shop
Sign In
My Account
LED Light Therapy Consent Form
Name
*
First Name
Last Name
Date of Birth
*
MM
DD
YYYY
By my electronic signature below, I acknowledge that I have read and fully understand this agreement and all information detailed below *
*
This applies to the area that you plan to have treated
I do not have photo-sensitivity
I am not prone to epilepsy/seizures
I do not have active cold sores
I am have a sunburn
I do not have malignant skin tumors
I am not going under cancer therapy (chemotherapy/radiation)
I have not received cortisone or steroid injections within 5 days
I have not used prescription retinoids (Tretinoin, Retin-A etc.) within 7 days
I have not receved botox/fillers/injectibles within 2 weeks
I have not used Accutane within 6 months
I am not pregnant
Signature
*
Date
*
MM
DD
YYYY
Thank you!