• Clover Beauty LLC

    Treatment Consent

  • Dermaplaning Consent

    Please initial to indicate your acknowledgment
  • I understand that dermaplaning is an exfoliating treatment that involves the use of a sterilized surgical blade to remove dead skin and fine vellus hair from the face and neck*
  • The nature and purpose of dermaplaning has been explained to me and any questions I have regarding the treatment have been answered to my satisfaction prior to the procedure*
  • I understand that the treatment may involve the risk of complication or injury and I freely assume those risks. Possible side effects of the treatment area can include mild redness, mild irritation, and dryness. Additionally, superficial nicks to the skin can occur due to the sharp surgical blade and will heal within a few days*
  • If a chemical peel or enzyme is included with this treatment, I understand that the sensation and penetration of the peel or enzyme will be enhanced. This may cause skin irritation, mild discomfort, tenderness, lightening or darkening of the skin, infection, scarring, peeling, and activation of cold sores, when the virus is already present in the body*

  • By signing this form, I acknowledge that I am aware of the risks involved and give consent to receive dermaplaning from my esthetician/Clover Beauty LLC. I understand that this agreement is binding and will remain in effect for all immediate and future services/procedures received at Clover Beauty LLC. I certify that I have read and understand this entire consent form and I and agree to the information provided in this form. I certify that I am at least 18 years of age and give my consent to treatment. The treatments I receive here are voluntary and I release Clover Beauty LLC and/or the esthetician from liability and assume full responsibility thereof.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
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