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Hydrafacial Treatment Consent

HydraFacial is the only hydradermabrasion procedure that simultaneously combines cleansing, exfoliation, extraction, hydration, and antioxidant protection, resulting in clearer, more beautiful skin with little to no downtime.   

 

The treatment is soothing, moisturizing, non-invasive, and generally non-irritating. As with most procedures, visible results from HydraFacial will vary from person to person.  

 

What to expect: 

â–ªYour skin may experience temporary irritation, tightness, or redness. These are all normal reactions that typically resolve within 72 hours, depending on skin sensitivity.  

â–ªYou may experience tingling and stinging in the treatment area. These sensations generally subside within a few hours.  

â–ªClient experiences may vary. Some clients may experience a delayed onset of these symptoms.  

â–ªYou will likely see results immediately after treatment, and your skin may feel smooth and hydrated for one to four weeks with appropriate home care to maintain treatment results.  

â–ªThe skin is more susceptible to sunburn/sun damage. Avoid excessive sun exposure and use a minimum of SPF 40 sunscreen.  

Do you have the following?

Active acne or infection
Open lesion or cold sore
An active infection in the treatment area
Active sunburn
Skin condition such as eczema, dermatitis, or rashes
An autoimmune disease such as lupus
A viral concern as HIV or hepatitis
Anticoagulants Therapy
Melanoma or lesions suspected of malignancy
Pregnancy or lactation
Neurological disorders such as epilepsy (LED Lights)
Infection in the urinary system i.e. kidneys, bladder and uretha (Lymphatic drainage)
Crohn's Disease (Lymphatic drainage)
Hyperthyroidism (Lymphatic drainage)
Deep Venous Thrombosis (Lymphatic drainage)
Lymphedema (Lymphatic drainage)

*Saying yes does not preclude you from receiving treatments.

Have you recently?

Used Accutane, topical medications or antibiotics
Had aesthetics fillers, injectables or laser treatments

I acknowledge the following: â–ª â–ª â–ª â–ª

 

  •  I willavoidusingf aggressive exfoliation, waxing, and products containing glycolic acids orretinols that are not part of the recommended take-home regimen in the treated areas for minimumtwo2 weeks pre-and post-treatment. 

  • Photos may be taken before, during, and after the HydraFacial treatment. Photos will only be used with my written approval for education, promotion, or advertising purposes. ,

  • The information provided has been explained to me, and all my questions have been answered to my satisfaction. I have read the above information, and I consent to have the HydraFacial treatment by the staff at Galleria Spa Salon Boutique. 

  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the HydraFacial System. 

  • This consent form is valid for all future HydraFacial treatments. I will alert the staff If there are any future changes to my medical history.

Thanks for submitting!

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