The Healthy Touch Day Spa Microdermabrasion Consent Form

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The Healthy Touch Day Spa
Microdermabrasion Consent Form
Informed Consent for Microdermabrasion
Microdermabrasion projects a flow of corundum over the skin and abrades away
epidermis tissue in the areas treated. It is done so precisely that normal surrounding
tissue is hardly affected. Microdermabrasion is used to treat acne, scars, wrinkles,
blackheads, hyperpigmentation and other groups of skin conditions. The process
takes anywhere from 2-12 treatments to achieve desired results.
After a treatment, the skin may feel tight as if exposed to the sun and wind.
Additionally, you may experience streaking of the skin that is slightly pink or red
in orientation. Slight redness or pink coloration is normal. Keep the skin well
moisturized.
Your fresh newly exposed skin will be delicate. Protect it from the sun by using a
sunscreen with a protective factor of 20 or higher. Apply cortisone directly to the
skin if you should experience itching following your treatment.
Keep the treated area clean and moist. Avoid any type of UVA/UVB exposure for
24-48 hours. Please note: Clients will not be treated if artificial tanning lamps are
used directly before or after the procedure.
If you are a contact lens user, please remove lenses before each treatment. It is the
client s responsibility to remember to do this.
I acknowledge that there are no guarantees to the percentage of improvement in the
skin following treatment.
I understand that no specific results are guaranteed.
BY SIGNING THE BELOW, I ACKNOWLEDGE THAT I HAVE READ THE
PRECEEDING INFORMATION AND AGREE TO THE TREATMENT WITH
ITS ASSOCIATED RISKS. I HEREBY GIVE CONSENT TO THE HEALTHY
TOUCH DAY SPA TO PERFORM MICRODERMABRASION TREATMENTS.
Date _____________________________________________________
Signature_________________________________________________
 

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