• Dermaplaning Intake Form

  • General Information

  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Medical History

  • Do you currently or have you had any of the following? Please check all that apply:
  • Do you have any other allergies?*
  • Are you currently on any blood-thinning prescription or non-prescription drugs?*
  • Are you currently taking any medications?*

  • Skin Care History

  • Check the products that you currently use (please select all that apply):
  • What type of skin do you have?*
  • Have you had any facial or dermatology services in the past 30 days?*
  • Have you used Retin-A. Renova. AHAS or Retinal products in the last three months?*
  • Have you received Botox, Lip Fillers, Restylane, Juvederm or Collagen injections in the last 6 months?*

  • Important Information

  • What concerns do you have regarding your skin? Please select a ll that apply:

  • Cavitation Consent Form

  • Please read and initial each of the statements below:*

  • 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.

     

  • 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.

  • Should be Empty: