What is your main goal for today's treatment?

I understand, have read and completed this questionnaire truthfully. I agree that this constuites full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin/body from treatments received. I am aware there are often inherent risks associated with skin/body treatments and that the services I am about to receive could have unfavorable results including, but not limited to: allergic reactions, irritations, burning, redness, scarring, soreness, etc. By signing below, I further agree that I will not hold Aesthetics MD LLC or its affiliates or any of its employees responsible should there be any unfavorable outcome or result.