Technician's Name: Mindy Kim & Employees

I certify that I have read and fully understand the consent and procedure permit, that the explanations therein referred to were made and accept full responsibility for these and other complications, which may arise or result during or following the procedure. The treatment is performed at my request according to this consent pre-procedure form and post-procedure guidelines. All services rendered at Mindy Skincare are non-refundable. I hereby authorized Mindy Skincare technicians to perform this procedure on me.