Dermaplaning_Consent

Dermaplaning Intake Form
General Information
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Cavitation Consent Form
Please read and initial each of the statements below:*

I certify I am over the age of 18.I understand that dermaplaning is a physical/mechanical form of exfoliation using a specialized dermaplaning blade for the removal of built-up dead skin cells and vellus hair. Following treatment skin will be smoother. softer, and better able to absorb the active ingredients in treatment and home care products.I have been informed of the nature, risks, and possible complications, and consequences of dermaplaning. I understand this treatment involves the use of the sterile. surgical blade to remove dead skin cells and vellus hair. As with the use of any sharp instrument, there is the possibility of nicks or cuts.I understand there are contraindications to this treatment, including but not limited to, diabetes (not controlled by diet or medication). cancer. active acne. bleeding disorders. the inability for blood to coagulate. or the development of keloids following injury. Certain medications including blood thinners, higher dosages of Aspirin, and Accutane are contraindicated for this treatment due to the possibility of delayed clotting from a nick or cut.I certify that I am not taking any of the above medications or experiencing any of the above conditions. While every precaution will be taken to avoid nicks, cuts, and scratches, I understand the risks and consent to treatment today.I understand that my esthetician only utilizes sterilized, disposable equipment to minimize the risk of infection or contamination and that my esthetician has received training inappropriate sanitation and hygiene techniques prior to performing any procedures. While the risk of infection from our procedures is extremely small, the possibility of such an occurrence cannot be totally prevented. Accordingly. I understand and accept the risk and release my esthetician and the spa from any and all liability related to the subject procedure, except instances involving gross negligence.I grant permission to Lancaster’s Luxe Lashes to take and use: photographs and/or digital images of me for use in news releases, educational materials and/or social media platforms including but not limited to lnstagram, Facebook, Twitter, Tic Toe, and Pinterest.

Consents
I hereby grant and authorize Lancaster’s Luxe Lashes the right to take, edit, alter, copy, exhibit. publish, distribute and make use of any and all pictures. video, and/or audio is taken of me to be used in and/or for any lawful promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, press kits, websites, social networking sites, and other print or digital communications without payment or any other consideration. This authorization extends to all languages, media, formats, and markets now known or later discovered. I waive the right to inspect or approve the finished product wherein my likeness appears, including a written or electronic copy. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I hereby hold harmless and release Lancaster’s Luxe Lashes from all liability, petitions. and causes of action which I. my heirs. representatives. executors. or any other persons may make while acting on my behalf or on behalf of my estate.
By signing below I knowingly and willingly consent to release any and all liability for the unintent ional exposure or harm due to COVID- I9.

By signing below, I agree to the following:
have read or have had read to me the contents of this whole form. I understand the risks and a lternatives involved in this/these procedure(s) and I have had the opportunity to ask questions and all of my questions have been answered. I accept full responsibility for the decision to have dermaplaning done and understand that there is a no refund policy. I acknowledge that I have reviewed and approved the material given to me.
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Dermaplaning Aftercare Instructions
For the first 24 hours after a dermaplaning seNice, avoid the following to prevent skin irritation:
- Touching or scratching the treated area
- Hot baths or showers ( cool or lukewarm water only)
- Saunas, hot tubs, pools, or steam rooms
- Massage or friction in the treated area
- Rubbing your skin dry
- Tanning (sunbathing, sunbeds, or fake tans)
- Exfoliating the treated area
- Exercise or other activities which cause you to sweat
- Applying products to the treated area ( including make-up, lotions, soaps, powders, perfumes, harsh cleaning products, and self-tanning products)
For the first two weeks after a dermaplaning service, avoid the following to prevent skin irritation:
- Booking in any other facial treatments
- Direct sun exposure
- Complicated skincare routines. Simply use water and/ or a very mild cleanser.
It is important to moisturize your freshly exfoliated skin regularly to rehydrate it. Try to avoid direct sun exposure for 2 weeks post-treatment and then use sunscreen (SPF 30+) to protect your delicate facial skin.
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Dermaplaning Intake Form

Medical History

Skin Care History

Important Information

Cavitation Consent Form

Consents

Dermaplaning Aftercare Instructions