Dermaplaning Consultation and Consent Form

First Name

Last Name

Phone

Birthday

Address

Occupation

How often do you exercise?

Please list any skin or health conditions you are experiencing

Dermaplaning will gently exfoliate and eliminate surface layers of dead skin cells and unwanted vellus hair (peachfuzz) and will prime skin for our professional enzyme or acid peel. Professional enzymes or acid peels dramatically diminishes the appearance of discoloration, while smoothing texture and renewing the appearance of pores, to restore a brighter, more clarified skin tone. For optimal results, a series of 4-6 treatments every 4 weeks is recommended.

Risks / Side effects

All things considered, Dermaplaning is very safe.- Of course, bleeding is possible as the treatment involves the use of a sharp surgical blade. As with your own shaving experiences in the shower, cuts are extremely rare and more annoying than painful.- Makeup may be applied after Dermaplaning, in fact you may note that your makeup glides on and sits much better on your face after a session than before.- Your therapist will take every precaution to ensure that your skin is well hydrated and calm following each session. However, you may experience excessive dryness or even some peeling between sessions, which may or may not be normal.- More sensitive skin may experience some redness after the first couple of sessions. This normally goes away after 2 to 3 hours.- Dermaplaning may cause minor superficial abrasions which may not appear until a day or two following your treatment. If this should occur, please contact us so that we can arrange a post-treatment follow up with you.- After your treatment, SPF 30+ MUST be worn at all times.- Always seek medical advice if you have any concerns or complications, as well as informing us.

Contraindications

Although it is impossible to list every potential risk and complication, the following conditions are recognized as contraindications for dermaplaning treatment and must be disclosed prior to treatment

If you have ticked any of the above contraindications please give details:

Results

The majority of our clients receive noticeable, satisfactory, above average results with a series of treatments and a commitment to a daily skin care regimen. However, this outcome cannot be guaranteed as maximum results are highly dependent on age, cumulative sun exposure, health, lifestyle, genetic traits, general skin condition, and willingness to follow recommended protocols. Be aware that many changes may occur deeper within the skin over time. To continue the maintenance of your skin after you complete your treatment(s), your practitioner may inform you of other preventive treatments that may benefit your skin and help with management of your skin.

Pre-treatment Instructions

- Please discontinue products containing any exfoliating agents (retinoic acid, tretinoin, retinol, benzoyl peroxide, glycolic acid, salicylic acid, astringents, etc.) at least 72 hours before treatment.- A history of herpes or cold sores may require a course of antiviral medication pre and post treatment.- Your provider will recommend appropriate products to help enhance results and/or minimize potential side effects.- In regards to Isotretinoin (Anti-Acne), also known as Accutane, you can only be treated if the medication has not been taken within the last six months.

Maintenance Instructions

- You may experience slight redness and swelling, which should resolve within 24 hours.- Apply SPF 30 and UV Ray protection daily post treatment.- Mineral make-up can be worn immediately following treatment.- Avoid heat, saunas, hot tubs and all sweat-inducing activity for 24 hours; this includes exercise of any kind.- Avoid products containing any exfoliating agents (retinoic acid, retinol, tretinoin, retinol, benzoyl peroxide, glycolic acid, salicylic acid, astringents, etc.) for 7 days post treatment.- You may resume your regular skin care routine (excluding the points made above) 24 hours after treatment.

Consent Statements

Please read the following information carefully and tick the appropriate boxes to show your understanding and acceptance:

I understand that the treatment may involve the risk of complication or injury and I freely assume those risks.

Possible side effects of the treatment area can include mild redness of the skin, irritation and dryness. Additionally, nicks to the skin can occur due to the sharp surgical blade. Clients will be notified and the area will be treated if necessary.

The hair is expected to grow back blunt-ended. New hair will not appear darker or denser, however I do understand that any hormonal imbalance that may be present within my anatomical system can alter my normal hair growth pattern.

I have read the contents of this consent form carefully and I fully understand it. I have been given the opportunity for discussion pertaining to the treatment and all my questions have been answered to my satisfaction.

I understand that the sensation and penetration of the peel will be enhanced which may cause skin irritation, mild discomfort and tenderness.

I hereby release the practitioner against any and all liability associated with this procedure. I have been adequately informed of the risks and benefits of this treatment and wish to proceed with the treatment.

By my electronic signature below, I acknowledge that I have read and fully understand this agreement and all the information detailed above.

Your Signature

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