Consent for Treatment with

AQUAGOLD® fine touch

 

AquaGold is based on the skin's natural ability to repair itself. AquaGold treatments creat superficial "micro-channels" to the outermost layer of the skin, inducing the healing process including new collagen production. AquaGold has been shown to reduce the visibility of acne scars, fine lines and wrinkles, diminish hyperpigmentation and improve skin tone and texture.

I hereby authorize Beauty Marx and the appointed provider to perform my AquaGold treatments. I consent to AquaGold treatment containing Botox micro units, HA, vitamins, and possible PRP and/or growth factors.

I understand  possible side effects include and are n ot limited to: Slight or extreme redness, histamine reaction, swelling, stinging, itchy, tender, dry or flaking skin. In rare instances, hyperpigmention and/or hypopigmentation, scarring, nodule formation, or infection can occur. I understand that I should only apply products recommended by my provider post treatment.

Most side effects will gradulally diminish over time as healing may take several days. Notify your clinician immediately if any side effects cause extreme discomfort or any unexpected problems occur.

I have avoided the following products/procedures ​THREE DAYS prior to 

• Topical prescriptions including but not limited to Retinol, Tretinoin, Differin, Tazorac
• Abrasive scrubs or other exfoliating products

I have not had any cosmetic injections within the last ​TWO WEEKS.

Notify your physician PRIOR TO SIGNING THIS CONSENT if any of the following apply to you:

• Cold sores (or history of), warts, open skin lesions, sunburn, extreme sensitivity,  rosacea
• Accutane or generic within the past year
• Received chemotherapy or radiation therapy
• Collagen Vascular Disease
• Ecsema, Psoriasis, or Dermatitis
• Hemophilia/bleeding disorders
• Pregnant or breastfeeding
• Keloid/hypertrophic scarring
• History of autoimmunine disease or any condition that may weaken your immune system
• Blood thinning medication

I am undergoing treatment of my own free will. I agree that this procedure is being performed for cosmetic reasons and that no guarantee can be made as to the exact result of this procedure. I understand that althought I may see a change after my first treatment; I may require a series of sessions to obtain my desired outcome. The procedure contraindictations, precaustions and warnings have been explained to me including alternative methods; as have the advantages and disadvantages. I am advised that though good results are expected, the possiblity and nature of complications cannot be fully anticipated. Multiple treatments may be necessary to achieve optimal results.

 

ACKNOWLEDGMENT:​ By my signature below, I certify that I have read and fully understand the contents of this AquaGold consent form and that the disclosures referred to herein were made to me.

Note: Prices are subject to change without notice.