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:
Stinging, itching or irritation
Redness and swelling of the skin
Tightness, peeling or scabbing of treated skin and surrounding areas
Skin sensitivity to wind, sun or other environmental factors
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:
My diagnosis of diabetes
That I am a patient under a physicians care
My use of all medications and supplements, including antibiotics
My use of Isotretinoin (Accutane) in the past 12 months
Any history of radiation to the region
Herpes simplex or active infection
My history of hypertrophic scar formation
I agree to the following:
• That I am not pregnant or breastfeeding
That I have not used Retinoids, Hydroxy Acids or Benzoyl Peroxide for at least one week
That I will not use Retinoids, Hydroxy Acids or Benzoyl Peroxide until my skin is healed
That I have not waxed in the past week, or shaved the treated area for 24 hours
That I will avoid hot baths/showers, sweating and strenuous exercise for one week post procedure
That I will avoid rubbing, picking and scrubbing my skin post procedure, as it may result in scarring, hyperpigmentation or other skin damage
That I will protect my skin from any sun exposure with a broad spectrum sunscreen of at least SPF 30 daily
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
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.
Thanks for submitting!
The Treatment Room
Before & After Pics