Informed Consent for Advanced Treatments:
I acknowledge that no guarantee has been made regarding the results of this procedure. Although it is impossible to list every potential risk and complication, I have been informed of the possible risks and complications which may include, but are not limited to the following:
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Stinging, itching or irritation
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Redness and swelling of the skin
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Tightness, peeling or scabbing of treated skin and surrounding areas
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Skin sensitivity to wind, sun or other environmental factors
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Darkened pigmentation
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Any potential risks and complications could result in the need to discontinue the treatment. In this case, alternative recommendations will be suggested It is very rare that a permanent disability occurs. In case of complication during or after the treatment, I authorise my aesthetician or physician to perform any necessary treatments.
I certify that I am at least eighteen (18) years old.
I confirm I have informed my aesthetician of the following:
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My diagnosis of diabetes
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That I am a patient under a physicians care
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My use of all medications and supplements, including antibiotics
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My use of Isotretinoin (Accutane) in the past 12 months
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Any history of radiation to the region
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Herpes simplex or active infection
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My history of hypertrophic scar formation
I agree to the following:
• That I am not pregnant or breastfeeding
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That I have not used Retinoids, Hydroxy Acids or Benzoyl Peroxide for at least one week
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That I will not use Retinoids, Hydroxy Acids or Benzoyl Peroxide until my skin is healed
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That I have not waxed in the past week, or shaved the treated area for 24 hours
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That I will avoid hot baths/showers, sweating and strenuous exercise for one week post procedure
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That I will avoid rubbing, picking and scrubbing my skin post procedure, as it may result in scarring, hyperpigmentation or other skin damage
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That I will protect my skin from any sun exposure with a broad spectrum sunscreen of at least SPF 30 daily
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I have received a patch test prior to my treatment, I have read and will follow any and all instructions to the best of my ability
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I understand the potential risks and complications, and choose to proceed after careful consideration of the possibility of both known and unknown risks, complications, limitations and alternatives.
