Idemnity Form

Indemnity Form / Client Confidentially Form 

Name *
Address *
Date of Birth *
Date of Birth
Phone *
Please check all that apply *
Have you had any of the following services? *
Check all that apply
I request and consent to these procedures being carried out today without undergoiong a sensitivity patch test. The sensitivity test, which if conducted, may indicate my sensitivity/ allergy to the products. I understand the contents of this form and take full responsibility for my actions, thus absolving all other parties of their responsibilites, if any, associated with the supply of the products and service(s).