Microdermabrasion Consent Form - Afterglow Spa printable pdf download

MICRODERMABRASION CONSENT FORM

CLIENT NAME: __________________________ DATE: ______________

Prior to this treatment I have been candid in revealing any condition that may have a

bearing on this procedure, such as pregnancy, recent facial peels, surgery, allergies,

tendencies to cold sores, fever blisters and use of Accutane 4 weeks prior. Retinols and

AHA’s have not been used 3 days prior to this treatment and will not be used within 3

days after treatment. Use of depilatories, waxing, electrolysis, collagen injections

stopped during the treatments and I will wait at least seven days after conclusion.

I understand that no specific results are guaranteed with this procedure.

I understand that to achieve significant results, it will take series of treatments in

combination with the use of daily professional products. (Product recommendation will

be provided.)

I understand that pinkish and redness to the skin is very common and may last several

hours and could persist for a few days. I understand that irritation may exist and I

understand I should notify my skin care professional if irritation persists.

I will follow the home care program specifically designed for me.

Avoid any type of UVA/UVB exposure for at least 48 hours following this procedure.

Your fresh newly skin will be delicate and protect your skin from the sun by using a

sunscreen with a protective factor of SPF 30 or higher on a daily basis. Keep the skin

well moisturized.

Acne Clients: I understand that I may experience a slight acne flare up, and that my acne

condition may temporarily look worse for a few days after a microdermabrasion

treatment.

I agree to all of the above to have this treatment performed on me today and for all

subsequent treatments.

I do not hold my skin care professional, who signature appears

below, responsible for any of my conditions that are present, but not disclosed at the time

of this skin care procedure. I will notify my skin care professional of any changes to my

medical history or change in my skin care products. I will follow all prescribed directions

post treatment.

Client Signature _________________________Date __________________

Esthetician Signature _______________________ Date_________________

** This form should be signed and dated by the Esthetician providing treatment.

Microdermabrasion Consent Form - Afterglow Spa