{"id":6272,"date":"2020-07-10T14:01:11","date_gmt":"2020-07-10T14:01:11","guid":{"rendered":"https:\/\/bellaradiance.com\/?page_id=6272"},"modified":"2020-07-10T14:15:34","modified_gmt":"2020-07-10T14:15:34","slug":"obagi-blue-peel-consent-form","status":"publish","type":"page","link":"https:\/\/bellaradiance.com\/obagi-blue-peel-consent-form\/","title":{"rendered":"Obagi Blue Peel Consent Form"},"content":{"rendered":"<h1>\n\t\tOBAGI CONSENT FORM\n\t<\/h1>\n\t<div class=\"caldera-grid\" id=\"caldera_form_1\" data-cf-ver=\"1.9.7\" data-cf-form-id=\"CF5f086a9fc0f26\"><div id=\"caldera_notices_1\" data-spinner=\"https:\/\/bellaradiance.com\/wp-admin\/images\/spinner.gif\"><\/div><form data-instance=\"1\" class=\"CF5f086a9fc0f26 caldera_forms_form cfajax-trigger\" method=\"POST\" enctype=\"multipart\/form-data\" id=\"CF5f086a9fc0f26_1\" data-form-id=\"CF5f086a9fc0f26\" aria-label=\"Obagi Consent\" data-target=\"#caldera_notices_1\" data-template=\"#cfajax_CF5f086a9fc0f26-tmpl\" data-cfajax=\"CF5f086a9fc0f26\" data-load-element=\"_parent\" data-load-class=\"cf_processing\" data-post-disable=\"0\" data-action=\"cf_process_ajax_submit\" data-request=\"https:\/\/bellaradiance.com\/cf-api\/CF5f086a9fc0f26\" data-hiderows=\"true\">\r\n<input type=\"hidden\" id=\"_cf_verify_CF5f086a9fc0f26\" name=\"_cf_verify\" value=\"e3b3389ae5\"  data-nonce-time=\"1712207416\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/6272\" \/><div id=\"cf2-CF5f086a9fc0f26_1\"><\/div><input type=\"hidden\" name=\"_cf_frm_id\" value=\"CF5f086a9fc0f26\">\r\n<input type=\"hidden\" name=\"_cf_frm_ct\" value=\"1\">\r\n<input type=\"hidden\" name=\"cfajax\" value=\"CF5f086a9fc0f26\">\r\n<input type=\"hidden\" name=\"_cf_cr_pst\" value=\"6272\">\r\n<div class=\"hide\" style=\"display:none; overflow:hidden;height:0;width:0;\">\r\n<label>Phone<\/label><input type=\"text\" name=\"phone\" value=\"\" autocomplete=\"off\">\r\n<\/div><div id=\"CF5f086a9fc0f26_1-row-1\"  class=\"row  first_row\"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_3823079\" class=\"form-group\" id=\"fld_3823079_1-wrap\">\r\n\t<label id=\"fld_3823079Label\" for=\"fld_3823079_1\" class=\"control-label\">Name<\/label>\r\n\t<div class=\"\">\r\n\t\t<input placeholder=\"(enter full name)\"   type=\"text\" data-field=\"fld_3823079\" class=\" form-control\" id=\"fld_3823079_1\" name=\"fld_3823079\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_3823079Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<div class=\"\"><p>I have been fully informed by my practitioner and understand the following conditions relating to the use of the Obagi Nu-Derm System inclusive of the Tretinoin<\/p>\n<\/div><\/div><\/div><div id=\"CF5f086a9fc0f26_1-row-2\"  class=\"row  last_row\"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_5372015\" class=\"form-group cf-toggle-switch\" id=\"fld_5372015_1-wrap\">\r\n\t<label id=\"fld_5372015Label\" for=\"fld_5372015_1\" class=\"control-label\">The treatment programme has been explained and I am fully aware and committed to comply with the programme outlined by my skin practitioner.<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_5372015_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_5372015\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Agree\"  aria-labelledby=\"fld_5372015Label\" title=\"Choose OptionAgree\">Agree<\/a><a id=\"fld_5372015_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_5372015\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Disagree\"  aria-labelledby=\"fld_5372015Label\" title=\"Choose OptionDisagree\">Disagree<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_5372015_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_5372015\" data-ref=\"fld_5372015_1_opt1794845\" class=\"cf-toggle-group-radio fld_5372015_1\" name=\"fld_5372015\" value=\"Agree\"  data-radio-field=\"fld_5372015_1\" data-calc-value=\"Agree\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_5372015_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_5372015\" data-ref=\"fld_5372015_1_opt1905900\" class=\"cf-toggle-group-radio fld_5372015_1\" name=\"fld_5372015\" value=\"Disagree\"  data-radio-field=\"fld_5372015_1\" data-calc-value=\"Disagree\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_3180930\" class=\"form-group cf-toggle-switch\" id=\"fld_3180930_1-wrap\">\r\n\t<label id=\"fld_3180930Label\" for=\"fld_3180930_1\" class=\"control-label\">The cost of treatment has been advised and the specific treatment protocols have been discussed and established. I understand the prices quoted for my treatment programme.<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_3180930_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_3180930\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Agree\"  aria-labelledby=\"fld_3180930Label\" title=\"Choose OptionAgree\">Agree<\/a><a id=\"fld_3180930_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_3180930\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Disagree\"  aria-labelledby=\"fld_3180930Label\" title=\"Choose OptionDisagree\">Disagree<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_3180930_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_3180930\" data-ref=\"fld_3180930_1_opt1794845\" class=\"cf-toggle-group-radio fld_3180930_1\" name=\"fld_3180930\" value=\"Agree\"  data-radio-field=\"fld_3180930_1\" data-calc-value=\"Agree\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_3180930_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_3180930\" data-ref=\"fld_3180930_1_opt1905900\" class=\"cf-toggle-group-radio fld_3180930_1\" name=\"fld_3180930\" value=\"Disagree\"  data-radio-field=\"fld_3180930_1\" data-calc-value=\"Disagree\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_4102014\" class=\"form-group cf-toggle-switch\" id=\"fld_4102014_1-wrap\">\r\n\t<label id=\"fld_4102014Label\" for=\"fld_4102014_1\" class=\"control-label\">I understand that the individual or Bella Radiance will not be held liable for any adverse reactions as a direct or indirect result of my nondisclosure of any relevant facts or information requested during the consultation.<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_4102014_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_4102014\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Agree\"  aria-labelledby=\"fld_4102014Label\" title=\"Choose OptionAgree\">Agree<\/a><a id=\"fld_4102014_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_4102014\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Disagree\"  aria-labelledby=\"fld_4102014Label\" title=\"Choose OptionDisagree\">Disagree<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_4102014_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_4102014\" data-ref=\"fld_4102014_1_opt1794845\" class=\"cf-toggle-group-radio fld_4102014_1\" name=\"fld_4102014\" value=\"Agree\"  data-radio-field=\"fld_4102014_1\" data-calc-value=\"Agree\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_4102014_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_4102014\" data-ref=\"fld_4102014_1_opt1905900\" class=\"cf-toggle-group-radio fld_4102014_1\" name=\"fld_4102014\" value=\"Disagree\"  data-radio-field=\"fld_4102014_1\" data-calc-value=\"Disagree\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_1789394\" class=\"form-group cf-toggle-switch\" id=\"fld_1789394_1-wrap\">\r\n\t<label id=\"fld_1789394Label\" for=\"fld_1789394_1\" class=\"control-label\">I agree to inform Bella Radiance of any changes to my health that could affect my treatment.<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_1789394_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_1789394\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Agree\"  aria-labelledby=\"fld_1789394Label\" title=\"Choose OptionAgree\">Agree<\/a><a id=\"fld_1789394_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_1789394\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Disagree\"  aria-labelledby=\"fld_1789394Label\" title=\"Choose OptionDisagree\">Disagree<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_1789394_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_1789394\" data-ref=\"fld_1789394_1_opt1794845\" class=\"cf-toggle-group-radio fld_1789394_1\" name=\"fld_1789394\" value=\"Agree\"  data-radio-field=\"fld_1789394_1\" data-calc-value=\"Agree\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_1789394_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_1789394\" data-ref=\"fld_1789394_1_opt1905900\" class=\"cf-toggle-group-radio fld_1789394_1\" name=\"fld_1789394\" value=\"Disagree\"  data-radio-field=\"fld_1789394_1\" data-calc-value=\"Disagree\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_9000252\" class=\"form-group cf-toggle-switch\" id=\"fld_9000252_1-wrap\">\r\n\t<label id=\"fld_9000252Label\" for=\"fld_9000252_1\" class=\"control-label\">I understand the treatment programme is a minimum of 12-24 weeks to obtain the very best results for my skin concerns.<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_9000252_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_9000252\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Agree\"  aria-labelledby=\"fld_9000252Label\" title=\"Choose OptionAgree\">Agree<\/a><a id=\"fld_9000252_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_9000252\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Disagree\"  aria-labelledby=\"fld_9000252Label\" title=\"Choose OptionDisagree\">Disagree<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9000252_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_9000252\" data-ref=\"fld_9000252_1_opt1794845\" class=\"cf-toggle-group-radio fld_9000252_1\" name=\"fld_9000252\" value=\"Agree\"  data-radio-field=\"fld_9000252_1\" data-calc-value=\"Agree\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9000252_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_9000252\" data-ref=\"fld_9000252_1_opt1905900\" class=\"cf-toggle-group-radio fld_9000252_1\" name=\"fld_9000252\" value=\"Disagree\"  data-radio-field=\"fld_9000252_1\" data-calc-value=\"Disagree\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_657516\" class=\"form-group cf-toggle-switch\" id=\"fld_657516_1-wrap\">\r\n\t<label id=\"fld_657516Label\" for=\"fld_657516_1\" class=\"control-label\">I understand an expected time to treat my skin concerns will be outlined by my Practitioner, but may be subject to change.<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_657516_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_657516\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Agree\"  aria-labelledby=\"fld_657516Label\" title=\"Choose OptionAgree\">Agree<\/a><a id=\"fld_657516_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_657516\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Disagree\"  aria-labelledby=\"fld_657516Label\" title=\"Choose OptionDisagree\">Disagree<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_657516_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_657516\" data-ref=\"fld_657516_1_opt1794845\" class=\"cf-toggle-group-radio fld_657516_1\" name=\"fld_657516\" value=\"Agree\"  data-radio-field=\"fld_657516_1\" data-calc-value=\"Agree\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_657516_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_657516\" data-ref=\"fld_657516_1_opt1905900\" class=\"cf-toggle-group-radio fld_657516_1\" name=\"fld_657516\" value=\"Disagree\"  data-radio-field=\"fld_657516_1\" data-calc-value=\"Disagree\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_2268219\" class=\"form-group cf-toggle-switch\" id=\"fld_2268219_1-wrap\">\r\n\t<label id=\"fld_2268219Label\" for=\"fld_2268219_1\" class=\"control-label\">I am aware the the following are normal skin reactions: Redness, Dryness\/Flakiness\/Peeling, Skin Sensitivity, Breakouts of Spots, Tight feeling of the skin<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_2268219_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_2268219\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Agree\"  aria-labelledby=\"fld_2268219Label\" title=\"Choose OptionAgree\">Agree<\/a><a id=\"fld_2268219_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_2268219\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Disagree\"  aria-labelledby=\"fld_2268219Label\" title=\"Choose OptionDisagree\">Disagree<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_2268219_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_2268219\" data-ref=\"fld_2268219_1_opt1794845\" class=\"cf-toggle-group-radio fld_2268219_1\" name=\"fld_2268219\" value=\"Agree\"  data-radio-field=\"fld_2268219_1\" data-calc-value=\"Agree\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_2268219_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_2268219\" data-ref=\"fld_2268219_1_opt1905900\" class=\"cf-toggle-group-radio fld_2268219_1\" name=\"fld_2268219\" value=\"Disagree\"  data-radio-field=\"fld_2268219_1\" data-calc-value=\"Disagree\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_9167506\" class=\"form-group cf-toggle-switch\" id=\"fld_9167506_1-wrap\">\r\n\t<label id=\"fld_9167506Label\" for=\"fld_9167506_1\" class=\"control-label\">I have been fully informed of all normal skin reactions that can occur during the initial reactive phase of treatment. These reactions can last throughout the whole process depending on the individual skin concerns and I have been advised on how to deal with all of these normal skin reactions.<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_9167506_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_9167506\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Agree\"  aria-labelledby=\"fld_9167506Label\" title=\"Choose OptionAgree\">Agree<\/a><a id=\"fld_9167506_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_9167506\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Disagree\"  aria-labelledby=\"fld_9167506Label\" title=\"Choose OptionDisagree\">Disagree<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9167506_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_9167506\" data-ref=\"fld_9167506_1_opt1794845\" class=\"cf-toggle-group-radio fld_9167506_1\" name=\"fld_9167506\" value=\"Agree\"  data-radio-field=\"fld_9167506_1\" data-calc-value=\"Agree\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9167506_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_9167506\" data-ref=\"fld_9167506_1_opt1905900\" class=\"cf-toggle-group-radio fld_9167506_1\" name=\"fld_9167506\" value=\"Disagree\"  data-radio-field=\"fld_9167506_1\" data-calc-value=\"Disagree\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_7210647\" class=\"form-group cf-toggle-switch\" id=\"fld_7210647_1-wrap\">\r\n\t<label id=\"fld_7210647Label\" for=\"fld_7210647_1\" class=\"control-label\">I agree to attend regular 6 weekly assessments to monitor the changes in my skin and to discuss my progress to ensure my individual needs for my skin are addressed.<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_7210647_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_7210647\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Agree\"  aria-labelledby=\"fld_7210647Label\" title=\"Choose OptionAgree\">Agree<\/a><a id=\"fld_7210647_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_7210647\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Disagree\"  aria-labelledby=\"fld_7210647Label\" title=\"Choose OptionDisagree\">Disagree<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7210647_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_7210647\" data-ref=\"fld_7210647_1_opt1794845\" class=\"cf-toggle-group-radio fld_7210647_1\" name=\"fld_7210647\" value=\"Agree\"  data-radio-field=\"fld_7210647_1\" data-calc-value=\"Agree\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7210647_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_7210647\" data-ref=\"fld_7210647_1_opt1905900\" class=\"cf-toggle-group-radio fld_7210647_1\" name=\"fld_7210647\" value=\"Disagree\"  data-radio-field=\"fld_7210647_1\" data-calc-value=\"Disagree\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_9222072\" class=\"form-group cf-toggle-switch\" id=\"fld_9222072_1-wrap\">\r\n\t<label id=\"fld_9222072Label\" for=\"fld_9222072_1\" class=\"control-label\">I am aware that although Obagi is able to address a vast majority of my skin concerns there may be other treatments offered at Bella Radiance alongside the use of the products to obtain the very best results for my skin<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_9222072_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_9222072\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Agree\"  aria-labelledby=\"fld_9222072Label\" title=\"Choose OptionAgree\">Agree<\/a><a id=\"fld_9222072_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_9222072\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Disagree\"  aria-labelledby=\"fld_9222072Label\" title=\"Choose OptionDisagree\">Disagree<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9222072_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_9222072\" data-ref=\"fld_9222072_1_opt1794845\" class=\"cf-toggle-group-radio fld_9222072_1\" name=\"fld_9222072\" value=\"Agree\"  data-radio-field=\"fld_9222072_1\" data-calc-value=\"Agree\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9222072_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_9222072\" data-ref=\"fld_9222072_1_opt1905900\" class=\"cf-toggle-group-radio fld_9222072_1\" name=\"fld_9222072\" value=\"Disagree\"  data-radio-field=\"fld_9222072_1\" data-calc-value=\"Disagree\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_7085850\" class=\"form-group cf-toggle-switch\" id=\"fld_7085850_1-wrap\">\r\n\t<label id=\"fld_7085850Label\" for=\"fld_7085850_1\" class=\"control-label\">I understand that my treatment will be fully documented through out and photos will be taken on a regular basis to monitor my progress. A pre treatment photograph will be required.<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_7085850_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_7085850\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Agree\"  aria-labelledby=\"fld_7085850Label\" title=\"Choose OptionAgree\">Agree<\/a><a id=\"fld_7085850_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_7085850\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Disagree\"  aria-labelledby=\"fld_7085850Label\" title=\"Choose OptionDisagree\">Disagree<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7085850_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_7085850\" data-ref=\"fld_7085850_1_opt1794845\" class=\"cf-toggle-group-radio fld_7085850_1\" name=\"fld_7085850\" value=\"Agree\"  data-radio-field=\"fld_7085850_1\" data-calc-value=\"Agree\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7085850_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_7085850\" data-ref=\"fld_7085850_1_opt1905900\" class=\"cf-toggle-group-radio fld_7085850_1\" name=\"fld_7085850\" value=\"Disagree\"  data-radio-field=\"fld_7085850_1\" data-calc-value=\"Disagree\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_7828496\" class=\"form-group cf-toggle-switch\" id=\"fld_7828496_1-wrap\">\r\n\t<label id=\"fld_7828496Label\" for=\"fld_7828496_1\" class=\"control-label\">Bella Radiance may use any of my photographs for marketing, promotional or educational purposes. Although photographs will not contain my name or any other identifying information I am aware that I may, or may not, be identified by the photographs.<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_7828496_1_opt1794845\" data-label=\"I DO give permission for my photographs to be used\" data-field=\"fld_7828496\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"I DO give permission for my photographs to be used\"  aria-labelledby=\"fld_7828496Label\" title=\"Choose OptionI DO give permission for my photographs to be used\">I DO give permission for my photographs to be used<\/a><a id=\"fld_7828496_1_opt1905900\" data-label=\"I DO NOT give permission for my photographs to be used\" data-field=\"fld_7828496\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"I DO NOT give permission for my photographs to be used\"  aria-labelledby=\"fld_7828496Label\" title=\"Choose OptionI DO NOT give permission for my photographs to be used\">I DO NOT give permission for my photographs to be used<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7828496_1_opt1794845\" data-label=\"I DO give permission for my photographs to be used\" data-field=\"fld_7828496\" data-ref=\"fld_7828496_1_opt1794845\" class=\"cf-toggle-group-radio fld_7828496_1\" name=\"fld_7828496\" value=\"I DO give permission for my photographs to be used\"  data-radio-field=\"fld_7828496_1\" data-calc-value=\"I DO give permission for my photographs to be used\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7828496_1_opt1905900\" data-label=\"I DO NOT give permission for my photographs to be used\" data-field=\"fld_7828496\" data-ref=\"fld_7828496_1_opt1905900\" class=\"cf-toggle-group-radio fld_7828496_1\" name=\"fld_7828496\" value=\"I DO NOT give permission for my photographs to be used\"  data-radio-field=\"fld_7828496_1\" data-calc-value=\"I DO NOT give permission for my photographs to be used\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_7514475\" class=\"form-group cf-toggle-switch\" id=\"fld_7514475_1-wrap\">\r\n\t<label id=\"fld_7514475Label\" for=\"fld_7514475_1\" class=\"control-label\">Bella Radiance has provided me with information on all known possible side effects to enable me to make an informed choice whether to commence treatment. I understand that (clinic) cannot be held responsible for anyunknown side effects which, although unlikely may occur as a result of using Obagi.<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_7514475_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_7514475\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Agree\"  aria-labelledby=\"fld_7514475Label\" title=\"Choose OptionAgree\">Agree<\/a><a id=\"fld_7514475_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_7514475\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Disagree\"  aria-labelledby=\"fld_7514475Label\" title=\"Choose OptionDisagree\">Disagree<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7514475_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_7514475\" data-ref=\"fld_7514475_1_opt1794845\" class=\"cf-toggle-group-radio fld_7514475_1\" name=\"fld_7514475\" value=\"Agree\"  data-radio-field=\"fld_7514475_1\" data-calc-value=\"Agree\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7514475_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_7514475\" data-ref=\"fld_7514475_1_opt1905900\" class=\"cf-toggle-group-radio fld_7514475_1\" name=\"fld_7514475\" value=\"Disagree\"  data-radio-field=\"fld_7514475_1\" data-calc-value=\"Disagree\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_2649051\" class=\"form-group cf-toggle-switch\" id=\"fld_2649051_1-wrap\">\r\n\t<label id=\"fld_2649051Label\" for=\"fld_2649051_1\" class=\"control-label\">I understand that all of the information I have given is confidential and protected under the Data Protection Act and will not be released to a third party.<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_2649051_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_2649051\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Agree\"  aria-labelledby=\"fld_2649051Label\" title=\"Choose OptionAgree\">Agree<\/a><a id=\"fld_2649051_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_2649051\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Disagree\"  aria-labelledby=\"fld_2649051Label\" title=\"Choose OptionDisagree\">Disagree<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_2649051_1_opt1794845\" data-label=\"Agree\" data-field=\"fld_2649051\" data-ref=\"fld_2649051_1_opt1794845\" class=\"cf-toggle-group-radio fld_2649051_1\" name=\"fld_2649051\" value=\"Agree\"  data-radio-field=\"fld_2649051_1\" data-calc-value=\"Agree\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_2649051_1_opt1905900\" data-label=\"Disagree\" data-field=\"fld_2649051\" data-ref=\"fld_2649051_1_opt1905900\" class=\"cf-toggle-group-radio fld_2649051_1\" name=\"fld_2649051\" value=\"Disagree\"  data-radio-field=\"fld_2649051_1\" data-calc-value=\"Disagree\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_9298247\" class=\"form-group\" id=\"fld_9298247_1-wrap\">\r\n\t<label id=\"fld_9298247Label\" for=\"fld_9298247_1\" class=\"control-label\">Upload Pre Treatment Photograph Here<\/label>\r\n\t<div class=\"file-prevent-overflow\">\r\n\t\t<div id=\"fld_9298247_1_file_list\" class=\"cf-multi-uploader-list\"><\/div>\n\t\t\t\t<input type=\"file\" name=\"fld_9298247\" value=\"\" data-field=\"fld_9298247\" class=\"\" id=\"fld_9298247_1\" data-controlid=\"trupl660e36384fd83\"      aria-labelledby=\"fld_9298247Label\">\n\t\t<input type=\"hidden\" name=\"fld_9298247\" value=\"trupl660e36384fd83\">\n\t\t\t<\/div>\r\n<\/div>\r\n<div class=\"\"><p>By submitting this form, you agree that you are above the age of 18, and fully understand the questions asked above, answering truthfully throughout.<\/p>\n<\/div><div data-field-wrapper=\"fld_8980257\" class=\"form-group\" id=\"fld_8980257_1-wrap\">\r\n<div class=\"\">\r\n\t<input  class=\"btn btn-default\" type=\"submit\" name=\"fld_8980257\" id=\"fld_8980257_1\" value=\"Agree and Submit Form\" data-field=\"fld_8980257\"  >\n<\/div>\r\n<\/div>\r\n\t<input class=\"button_trigger_1\" type=\"hidden\" name=\"fld_8980257\" id=\"fld_8980257_1_btn\" value=\"\" data-field=\"fld_8980257\"  \/>\n<\/div><\/div><\/form>\r\n<\/div>\r\n\n","protected":false},"excerpt":{"rendered":"<p>OBAGI CONSENT FORM<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Obagi Blue Peel Consent Form - Botox Glasgow from \u00a3120 | Dermal Fillers Glasgow \u00a3100 | Clear Braces from \u00a3800<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/bellaradiance.com\/obagi-blue-peel-consent-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Obagi Blue Peel Consent Form - Botox Glasgow from \u00a3120 | Dermal Fillers Glasgow \u00a3100 | Clear Braces from \u00a3800\" \/>\n<meta property=\"og:description\" content=\"OBAGI CONSENT FORM\" 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