***Please Add Your Initials Where Applicable or Mark N/A Where It Is Not. This Form is for both Acne Clients and Facial Clients. TODAY'S DATE: April 20, 2024 IMPORTANT: PLEASE READ CAREFULLY and Initial VERY IMPORTANT: I understand my success is entirely dependent on following each step of the Clear Path Program. If I choose not to follow the step by step instructions consistently to achieve clear skin I should NOT expect to have 100% clear skin. I have NOT been exposed to excessive sun and my skin does not feel sensitive or irritated in any way. I have NOT had any other chemical peel or microdermabrasion of any kind within 14 days of this treatment. I have informed my Specialist of any use of antibiotics or topical prescriptions I may be using, including Retinoids (Retin-A, Renova, Avita, Differin, Tazorac or Accutane). I have informed my Specialist of all health problems and allergies of which I am aware. I understand that controlling acne/problem skin is best achieved through a series of recommended treatments and compliance to the home care program recommended by my Specialist, which is essential for ultimate results. We must adjust your home care routine on a regular basis to keep you progressing towards clear skin. If we don't change your at-home regimen often enough initially, your skin will adapt to the regimen and stop responding (thus plateau-ing so you won't get clear). When starting your at-home regimen it is normal to feel slightly dry; however, feeling uncomfortably dry and irritated is not. Let us know if this happens and we can help you with the dryness. I agree to contact my Specialist if my skin gets too dry and irritated. I understand that I need to follow my homecare instructions carefully to receive optimal results. If I decide to do any laser treatments or waxing of facial hair, I will inform my Specialist. While I am using my Specialist advised regimen, I will not use any other products that have not been approved.
I will inform my Specialist of any medications/drugs that I start taking while on their regimen. I will consult my Specialist before I make any changes to my regimen, stop using any of the products, or add other products to my at home regimen. While working with my Specialist and while I am in the process of clearing my skin, I will not run out of products. I understand that if I stop using or run out of products, acne will start forming and will show up within a few days or even up to a month. While I am being treated by my Specialist, I will NOT have other skin care treatments or procedures since this could interfere with my acne treatments and the condition of my skin. I acknowledge that the Clear Path Acne Clinic/ABQ Acne Clinic reserves the right to refuse service to anyone at any time. This may be due to, but not limited to, health concerns. If I am disrespectful towards staff I may NOT be invited back to continue my acne treatments. We do reserve the right to choose who we work with in order to ensure that this program and its clientele remain positive, and stay mutually beneficial. Bad behavior or disrespect will not be tolerated. We respect our clients and expect the same in return. It’s important to remember we are all on the same team working towards the same goal, which is clear skin. We respectfully ask that you do not bring children under the age of 10 to accompany you to your appointment, unless the appointment is for them. Please help us maintain a quiet and peaceful environment for all of our clients. I Agree I will use my sunscreen every morning, regardless of whether or not I will be going outside. I understand my sunscreen can provide additional hydration for my skin. I will NOT use any kind of tanning beds or lay in direct sunlight during my treatment process because I understand this can be highly damaging to my skin, especially while having acne treatments and using clinical strength skin care. (Women) I will inform my Specialist if I am or become pregnant. I understand that full payment is required at the time of consultation/treatment. I, the client (or parent/legal guardian of this client), give permission for the Acne Specialist at Clear Path Acne Clinic/ABQ Acne Clinic to provide a full in depth consultation, perform an acne treatment, and customize a skin care regimen with the goal of clearing my skin. I understand that my appointment is my responsibility. However, we do make our best effort to remind clients via text message and email. Even so, failing to recieve them or read them does not waive my responsibility for appointment times. Also, arriving 10 minutes after the start time of my appointment will result in a shorter treatment. If I am late for my appointment I may be charged as a NO SHOW and will be charged $50 fee per our policy. All clients under the age of 18 must be accompanied to their Intial Consultation and Treatment by a parent or legal guardian. I Agree **VERY IMPORTANT: If I am more than 10 minutes late for an appointment, my Acne Specialist does not guarantee I will be seen. If my Acne Specialist cannot fit me into the appointment schedule, I will be charged a $50 missed appointment fee. Also, if I cancel with less than 24 hrs notice or NO SHOW I understand that I will be charged a $50 late cancellation fee. It will be required that after a second No Show offense all future appointments must be prepaid in full. **MOST IMPORTANTLY: If we are unable to improve the condition of your skin due to factors beyond our control, but within yours, we reserve the right to decline treatments. (That is, if you are not following our instructions pertaining to home care, doing your home care regimen, diet, and following lifestyle guidelines.) I Agree RESCHEDULING AND NO SHOW GUIDELINES ARE STRICTLY ENFORCED. A 24-hour rescheduling notice is required. We realize emergencies happen and they will be considered, but we reserve the right to charge a $50.00 fee for missed appointments (NO SHOW) or late cancellation without a 24-hour notice. If you need to cancel or reschedule an appointment, call the front desk for assistance; please do not email. All rights reserved. In accordance with the US Copyright Act of 1976 the dupilication or redistribution of any, part of or all of the Clear Path Program without the permission of the Clear Path Acne Clinic/ABQ Acne Clinic constitutes unlawful piracy and theft of Clear Path Acne Clinic/ABQ Acne Clinic's intellectual property. If you would like to use material from the Clear Path Program please contact us. Violators will be prosecuted to the fullest extent of the law. I, consent to photographs taken of my face to be used for monitoring treatment progress. These photos will N be posted publicly without client's written consent. I Agree | 