Acne Intake Form

Please read the client expectations page 

https://www.skinbyjanny.com/expectations

Please review the page for home care instructions (password given after appointment).

https://www.skinbyjanny.com/acne-skin-care

 Acne treatment may consist of surface cleansing, mild chemical peels or steam and exfoliation, application of antibacterial serums, corrective serums, and extractions. Treatments take approximately 45-60 minutes and cost $160 per session. Treatments are designed to balance, hydrate, extract acne impactions, and prepare the skin for the home care routine. Implements and equipment used in this facility are disposable or sterilized adequately according to the State Board of Cosmetology regulations . 

WARNINGS: Please Read Carefully 

 

● Avoid direct sunlight or tanning booths for at least 3 days following treatment.

● Use of sunblock protection is necessary following all treatments.

● Do not pick your skin following a treatment.

● Face Reality Skincare products are clinical-strength active formulas. Mild tingling sensations are possible with product application but should not be irritating.

● If you are experiencing stinging and/or irritation with any product, stop using the product and contact your Acne Expert for guidance.

● We must adjust your home care routine every two weeks to keep your progress to clear skin moving forward. If we don’t change how you do your home care often enough, your skin will adapt to the regimen and stop responding (in other words, you won’t get clear). I agree to contact my skincare professional so we can adjust your home care regimen at least every two weeks

● Each time we strengthen your home care, we run the risk of drying and irritating your skin, so you will need to communicate that to us if that happens. I agree to contact my skincare professional if my skin gets uncomfortably dry and irritated.

 By signing this page, you agree that:

● I have not been exposed to excessive sun, and my skin does not feel sensitive or irritated.

● I have not had any other chemical peel, within 14 days of this treatment.

● I had no facial waxing within 7 days of this treatment.

● I have informed the clinic of all health problems I am aware of, including herpes simplex/cold sores.

● I have told the clinic of any use of oral or topical medications I may be using, including any retinoids (Retin-A, Renova, Avita, Differin, Tazorac) or Accutane (Isotretinoin).

● I understand that clearing the skin of acne is best achieved through a series of treatments and consistency with the home care product routine recommended by my Acne Expert.

● I understand that I will probably not experience much visible peeling, flaking, discoloration, or irritation following this procedure if I follow my home care instructions carefully.

● I will not use any other products that my skincare professional has not approved while I am on their regimen.

● I will not change the regimen given to me by my skincare professional without notifying or consulting with them first.

● I will not run out of product while working with my skincare professional. When you stop using products (or run out), acne will start forming inside the pores, and you will see it about a month later.

● I will not have other skin care treatments while my skincare professional is treating me.

● I will inform my skincare professional of any medications/drugs that I start taking while using their regimen.

● I will use my sunscreen every morning, regardless of whether or not I will be going outside. The sunscreen will help to keep your skin moisturized. Without it, your skin will get too dry.

● I will not get sunburned or windburned while being treated by my skincare professional. (You will not be able to use your active products, and we will not be able to treat you.)

● I will inform my skincare professional if I elect to do any laser treatments or waxing for hair removal.

● (For women) - I will inform my skincare professional if I get pregnant.

● I consent to photographs taken of my face to be used
for monitoring treatment progress.

● MOST IMPORTANTLY: If we cannot improve the condition of your skin due to factors beyond our control but within yours, we reserve the right to decline treatments. (That is, if you are not following our instructions about home care, doing your home care, lifestyle issues, etc.)