THE BEAUTY BUILDER SKIN CLASSIC CONSENT FORM

THE BEAUTY BUILDER SKIN CLASSIC CONSENT FORM
The Skin Classic direct high frequency technology is an affordable non-laser treatment for minor skin irregularities such as telangiectasis (broken capillaries), cherry angiomas, keratosis, fibromas, skin tags, hyperpigmentation, milia, sebaceous hyperplasia, and acne. Skin Classic treatments are quick, virtually painless, and work strictly on the epidermis to address common skin irregularities as the skin ages.

The Skin Classic precisely treats and/or removes each irregularity permanently, or semi-permanently, without the use of lasers, cutting, burning, or freezing which can effect areas of the skin not being treated. The Skin Classic utilizes a lamprobe to transmit an electric current to effectively vaporize and dehydrate the skin irregularity with little downtime and no damage to surrounding tissue.

Although rare, the following may occur with treatment:
1. DISCOMFORT - Some discomfort may be experienced during treatment. A light stinging sensation is felt in the areas being treated.

2. WOUND HEALING - Treatment can result in swelling, blistering, crusting, or flaking of the treated areas, which may require one to three weeks to heal. Once the surface has healed, it may be pink or sensitive to the sun for an additional two to four weeks, or longer in some patients.

3. BRUISING/SWELLING/INFECTION - Bruising of the treated area may occur. Additionally, there may be some swelling noted. Finally, skin infection is a possibility although rare, whenever a skin procedure is performed.

4. PIGMENT CHANGES (Skin Color) - During the healing process, there is a possibility that the treated area can become either lighter or darker in color compared to the surrounding skin. This is usually temporary, but, on a rare occasion, it may be permanent.

5. SCARRING - Scarring is a rare occurrence, but it is a possibility when the skin’s surface is disrupted. To minimize the chances of scarring, it is IMPORTANT that you follow all post treatment instructions carefully.

6. BLEEDING: Pinpoint bleeding is rare but can occur following HF treatment procedures. This is usually in the vascular areas being treated.

7. SKIN PATOLOGY: Energy directed at skin lesions may potentially vaporize the lesion. Only clearly benign pigmented lesions can be treated. Check with your dermatologist for clearance for the treatment if the lesion has changed in color, size, extremely elevated or is painful to the touch.

8. ALLERGY REACTION: In rare cases, local allergies to tape, preservatives used in cosmetics or topical preparations, have been reported.

You have the right to be informed so that you may make the decision whether or not to undergo the procedure, after knowing the risks involved. This disclosure is not meant to frighten you. It is simply an effort to make you better informed so you may give, or withhold, your consent to the procedure. Informed Consent and Waiver of Liability I hereby authorize and direct Danay Sweet of The Beauty Builder to perform the procedure of high frequency.
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I understand that the procedure is purely elective. Please inform me of any events you may have coming up in the next 30 days to ensure we have time allotted to heal.I understand that the skin treated may be red and swollen with fine, thin scabs forming days 2-10. Some larger scabs may form if we treat acne lesions or a larger cluster of capillaries. Also, small pustules are very common in pore treatment as well as capillary clusters.I understand I have to keep the treated areas dry until the thin scabs fall off. This healing process will take anywhere from 14-30 days but can take months in some cases. This post-inflammatory hyper-pigmentation is very common and will lighten in time. Skin takes time to heal. If we treat your hands, they will take longer to heal that another body parts because of the nature of washing our hands constantly.I understand I must not scratch or pick the scabs, as this can cause scarring and prolong the healing time. Even when you think they are ready. NO PICKING please :). Your heal time will be much longer if you pick off your scabs before they are ready to fall off.I understand that I may need multiple treatments for the desired outcome. Please do not get this treatment if you have an event coming up within 21 days of treatment. Your skin needs time to heal :)I understand the full healing process and recovery of skin color can take months in some cases. After 30 days you will have a reddish-pink tone. This is new healed skin and will fade in time. I have wonderful products available also to help facilitate this process more quickly.I understand that this treatment is not recommended for diabetics. I certify I am not diabeticI certify am not taking Accutane and did not take Accutane for at least 6 months prior to having treatment.I certify I do not have a pacemaker.I certify I am not pregnant, nor am I breastfeeding.I certify that I do not have active shingles or ACTIVE cold sores (herpes virus infections.)I was explained all aspects of treatment, complications, post care and understand them.I certify that my treatment spot (skin tag, pigment, milia, and capillaries are cancer free.)I understand that taking Before and After pictures is a condition of such procedures. I hereby forever release and discharge The Beauty Builder from any and all claims, action and demands arising out of use of said photographs.I give permission to use my photographs on social media or website. No photographs revealing my identity will be used without my written consent.
POST CARE

Until the thin scabs fall off:

Keep scab as clean and dry as possible. There may be redness around treated areas. Do not try to remove scab as it will come off naturally. Don't pick, don't pick, don't pick (from personal experience with this treatment, the healing process will take much longer if you pick your scabs.)

Shower with back to the water. Pat dry if skin gets really wet in treated areas.

Do not apply heavy makeup for at least 24 hours as it may irritate the treatment sites. Powder makeup or light tinted moisturizer is recommended. IF you wear a full face of makeup daily, just be gentle when taking makeup off at night.

No tanning for 30 days AFTER treatment. Avoid suanas until after scabs have fallen off.

Wear sunscreen of at least SPF 25 daily to protect your new skin.

During the healing process, a gentle cleanser, moisturizer, and SPF are all that are recommended. After the scab falls off you can return to your regular skincare regimen. (Acids, retinols, & active ingredients can resume after.)

Compliance with the aftercare guidelines is crucial for healing, prevention of scarring, hyperpigmentation and hypopigmentation.

Client may need to return to the office in 14 days so that we may observe the treatment site.

ACKNOWLEDGMENT: I shall not hold The Beauty Builder liable, nor shall place responsibility on The Beauty Builder should Electroerradication treatment cause me any unexpected problems. I am aware that I am accepting this treatment at my own risk and that The Beauty Builder shall be released of all responsibilities and liabilities should Skin Classic treatment cause any adverse effect.
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