Active Body Wellness


Jan Marini Skin Research® Informed Consent

Jan Marini Skin Research professional protocols are excellent in providing overall skin rejuvenation and can improve the appearance of fine lines and wrinkles, acne, acne scarring, sun damage and hyperpigmentation. I understand that individual results will vary and multiple peels may be necessary to achieve maximum results. A guarantee cannot be made about the degree of improvement.

I have been advised that my peel can consist of any of the following: glycolic acid, mandelic acid, salicylic acid, lactic acid, citric acid, resorcinol or retinol.
By my signature below, I acknowledge that I have read this Informed Consent and understand it. I acknowledge that I have fully disclosed all necessary information when filing out the Skin & Health Questionnaire and I will inform my skin care therapist or physician of any changes. I acknowledge that I understand and will follow all pre-/post-care recommendations, including, but not limited to use of skin care products as home care to enhance results and minimize side effects, such as daily application and reapplication as needed of a broad spectrum SPF 30+. I have been adequately informed of the risks and benefits of the peel and would like to proceed with the Jan Marini Skin Research peel.
Signature of Patient – Draw your signature below using a tablet, mouse or smartphone. By clicking the Submit button at the end of this form I understand and agree that this is a legal representation of my signature.
 
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