• Cryo Beauty Queen Skin needling Consent

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  • Skin needling / Collagen Induction Therapy Informed Consent                                    

    I understand there is no guarantee that can be given to me as to the condition of my skin or degree of improvement expected in the following treatment, that multiple treatments and the use of the recommended home skin care maintenance are required to achieve optimal results. I am not pregnant or lactating and I have told the medical staff about any allergies. 

    You are eligible for Skin-needling if the following applies to you: 

    - Lack of skin radiance, loss of elasticity and epidermal thickness, rough and uneven skin texture 

    - Fine lines, Wrinkles, Crow’s feet 

    - Hyperpigmentation, Scars, especially indented acne or chicken pox. Post surgical Scars 

    - Skin Dullness, Dry Skin   

     You are NOT eligible for Skin-needling if the following applies to you: 

    - You suffer with active pustular acne, Active bacterial, viral or fungal infections 

    - Eczema, Psoriasis, Rosacea, Actinic (solar) keratosis or Diabetes

    - Keloid or raised scars or scars less than 6 months old, presently using isotretinoin (Accutane)

    - Raised moles or warts, had facial surgery in the past 6 months 

    - Patients taking blood pressure, blood thinning or heart medications or Immunosuppression

    Side Effects

    After the procedure, the skin will be red and flushed in appearance in a similar way to moderate sunburn. You may also experience skin tightness and mild sensitivity to touch on the area being treated. This will diminish greatly after a few hours following treatments and within the next 24 hours the skin will be completely healed.         

    I understand that results will vary among individuals. I understand that although I may see a change after my first treatment, I will likely require a series of sessions to obtain my desired outcome. I am advised that though good results are expected, the possibility and nature of complications cannot be accurately anticipated and that, therefore, there can be no guarantee as expressed or implied either as to the success or other result of the treatment. I am aware that Skin-needling treatment is not permanent as natural degradation will occur over time. I state that I have and I understand this consent and the information contained in it. I have had the opportunity to ask any questions about the treatment including risks or alternatives and acknowledge that all my questions about the procedure have been answered in a satisfactory manner. 

    I have read the above information and I fully understand what to expect. I give permission to my skin therapist to perform the Skin-needling procedure we have discussed and will hold her, medical director and staff harmless from any liability that may result from this treatment. I understand she will take every precaution to minimize or eliminate negative reactions such as blisters, sores, or other reactions, as much as possible. I have given an accurate account of any over-the-counter or prescription medications that I use regularly. I am not ingesting or using topically any other over-the-counter product or prescription medication that has not been disclosed to my therapist. I have not had any recent radioactive or chemotherapy treatments, sunburn, windburn, or broken skin. I have not recently waxed or used a depilatory (such as Nair) on the area to be treated. I do not have a history of keloid scarring, excessive telangiectasia, viral infections, open lesions or rashes, active acne, any autoimmune disease, or any other existing condition that may interfere with the positive outcome of this treatment. 

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  • Cryo Beauty Queen Covid Waiver

  • I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
    I further acknowledge that Cryo Beauty Queen has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
    I further acknowledge that Cryo Beauty Queen can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, salon staff, and other salon clients and their families.
    I voluntarily seek services provided by Cryo Beauty Queen and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.
    I attest that:
    * I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
    * I have not traveled internationally within the last 14 days.
    * I have not traveled to a highly impacted area within the US in the last 14 days.
    * I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
    * I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.
    * I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
    I hereby release and agree to hold Cryo Beauty Queen harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from Cryo Beauty Queen. I understand that this release discharges Cryo Beauty Queen from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Cryo Beauty Queen. This liability waiver and release extends to the salon together with all owners, partners, and employees.

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