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    General Facial Consent

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    Eking In
    This document outlines the potential risks and side effects of facial or skin peeling treatments, as well as pre and post-treatment instructions. Common side effects include dryness, sensitivity, flaking and temporary dark spots. The document states that sensitivity testing is required before chemical peels. It notes contraindications like pregnancy, recent surgery, allergies and certain medications. It provides instructions to avoid sun exposure, saunas and chemical services after treatment. The patient consents that results are not guaranteed and multiple treatments may be needed. They agree to follow all pre and post instructions and notify staff of any issues.

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    General Facial Consent

    Uploaded by

    Eking In
    240 views2 pages
    This document outlines the potential risks and side effects of facial or skin peeling treatments, as well as pre and post-treatment instructions. Common side effects include dryness, sensitivity, flaking and temporary dark spots. The document states that sensitivity testing is required before chemical peels. It notes contraindications like pregnancy, recent surgery, allergies and certain medications. It provides instructions to avoid sun exposure, saunas and chemical services after treatment. The patient consents that results are not guaranteed and multiple treatments may be needed. They agree to follow all pre and post instructions and notify staff of any issues.

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    general facial consent

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    This document outlines the potential risks and side effects of facial or skin peeling treatments, as well as pre and post-treatment instructions. Common side effects include dryness, sensitivity, flaking and temporary dark spots. The document states that sensitivity testing is required before chemical peels. It notes contraindications like pregnancy, recent surgery, allergies and certain medications. It provides instructions to avoid sun exposure, saunas and chemical services after treatment. The patient consents that results are not guaranteed and multiple treatments may be needed. They agree to follow all pre and post instructions and notify staff of any issues.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    240 views2 pages

    General Facial Consent

    Uploaded by

    Eking In
    This document outlines the potential risks and side effects of facial or skin peeling treatments, as well as pre and post-treatment instructions. Common side effects include dryness, sensitivity, flaking and temporary dark spots. The document states that sensitivity testing is required before chemical peels. It notes contraindications like pregnancy, recent surgery, allergies and certain medications. It provides instructions to avoid sun exposure, saunas and chemical services after treatment. The patient consents that results are not guaranteed and multiple treatments may be needed. They agree to follow all pre and post instructions and notify staff of any issues.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    GENERAL CONSENT FORM AND INFORMATION FOR FACIAL (BODY) /PEELING/SKIN

    RESURFACING OR OTHER SKIN TREATMENTS AND POCEDURES

    Prior to receiving my treatments: I understand the goal of a facial or body skin treatments as in any cosmetic
    procedure, is improvement, not perfection. I understand that my results may not be perfect.

    Common Potential Side Effects are: Dryness, Sensitivity, Tiny scabs (where older acne impactions were removed),
    Flaking, Superficial temporary dark spots, Mild bruising, Scarring, Crusting, Itching, Redness, Infection, Swelling,
    Onset of Acne, Burning and Blistering, or any other unsatisfactory cosmetic results ( reactions specific to an
    individual ) are normal and temporary. Thus, sensitivity test for product or chemical peels is essential for safe
    procedures which will be done before performing the treatment.

    Contraindication, such as: pregnancy (if so, consult your physician prior to treatment), recent facial surgery,
    Allergies, cold sores/ fever blisters, use of Retin-A, Accutane (for the last 6 month) or any other medical
    prescriptions and other health issues.

    Using sauna, chemical hair services or skin peels, wax, use depilatory or be exposed to prolonged direct sun for at
    least 14days post procedure.

    if any Allergic Reactions: Call the Emergency or Doctor immediately, and temporarily discontinue your
    products.  Rub ice cubes on the skin in a circular motion for two minutes every hour, pat dry, and apply cold
    compresses. Allergy is rare and symptoms usually disappear in a day or wo. Inform your Therapist (clinic).

    By signing this form, you confirm and consent to the following:

    1. I understand there are no guarantees as to the results of this treatment, due to many variables, such as: age,
    condition of skin, sun damage, smoking, climate, health issues and etc.
    2. I understand that to achieve optimum results, I may need several treatments and use home care products as
    prescribe by my therapist.
    3. I agree to refrain from solariums/sun beds while I am undergoing treatment, and during the 30 days following
    the end of treatment.
    4. I understand that extended direct sun exposure is prohibited while am undergoing   treatment and the daily
    use of sunscreen protection with a minimum of SPF 30+ is mandatory.
    5. I further agree to follow all the pre and post skin treatment/resurfacing instructions as instructed by my
    therapist.
    6. I have not had any chemical peel of any kind (laser or other cosmetics procedures), within 14 (may vary) days
    prior the treatment. I understand I cannot have another treatment within 14 days (may vary) after my
    treatment whether it is performed at this location or any other location of the body.
    7. I have read the entire Informed Consent and was adequately explained the risks of this treatment,
    contraindications, guidelines and benefits from this treatment. I hereby consent to the treatment to be
    performed to me.
    8. Considering that I have been informed that certain medical conditions and medications are contraindicated
    thus, I have provided a full and truthful medical history and accurate account of my medications to this clinic.

    I agree to the  treatment  advised  to me by my therapist: (Select that apply )

    ☐Peeling / MDA
    ☐Cosmelan / Dermamelan
    ☐Mesotherapy / Biorevitalisation
    ☐Injection Lipolysis
    ☐Botox / Fillers
    ☐PRP / Growth Factor
    ☐Medical Facials / Combination with Medical Devices ( Machines )
    ☐Others  _________________________________

    I agree that if I should have any questions or concerns regarding my treatment/results I will notify immediately so that
    timely follow-up and intervention can be provided.

    Having been apprised of all the above, I have signed this Consent Form and authorize the subject treatment.

    Patient Full Name & Signature: __________________________ Date & Time:


    ___________________

    Therapist Name & Signature: ____________________________ Date & Time:


    ___________________

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