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Client Initials: Date: <br /> Acknowledgment and Release <br /> I understand that results vary between individuals and that potential risks include infection, <br /> allergic reactions, or dissatisfaction with results. I release the technician and facility from all <br /> liability for known and unknown complications arising during or after the procedure. <br /> Client Signature: Date: <br /> Technician Signature: Date: <br /> This form complies with California Health & Safety Code §§119302-119303. <br /> A copy of this form must be retained in client records for a minimum of three(3) years. <br />