New Client Consultation Form

Name*

First NameLast Name

Date*

MonthDayYear

What treatment are you getting today?*

Are you currently

Allergies?

If you are undergoing Microdermabrasion, Hydro-wand, Glycolic Peel or Flash Peel today, Read below for Side effects/post care instructions:

It is normal to experience redness, dryness or slightly irritated skin after undergoing any of these face related treatments.

Potentially, the skin will result in redness or dryness after Microdermabrasion, Hydro-wand, Flash Peel and Glycolic Peel. This will vary with each patient depending on age, skin type, sunlight exposure, & other environmental changes. Avoid direct sun exposure for at least 3 days post treatment. If avoiding sun exposure is not possible, wear a hat that covers the full face and reapply facial sunscreen each hour. Cleanse your face twice daily as normal. Follow up with a facial sunscreen that is Spf 30 or higher in the morning & EGF cream twice daily for at least 2-3 days. You must stay clear of using any active products that would cause your skin cells to turn over for 2-3 days. These products include Glycolic Acids, Benzoyl Peroxide (BPO), Vitamin C serums, and Retinols (including Supreme-A). Contact your Esthetician for any questions regarding post care questions or instructions.

If you are undergoing a Flash Peel: the healing period will vary depending on age, skin type, & environmental changes. Some clients take longer to peel than others. It is important to inform your Esthetician if you are open to having a deeper peel than your previous one. Some clients may require a series of peels before the intended goal is achieved. Follow the same post care instuctions in the paragraph above, but continue these instructions until your peeling, sloughing and flaking has completely stopped. Once your peeling has come to an end, return to active products & skincare routine as normal. Do not pick off or pull at the peeling on your face as it can result in scarring. Allow the epidermis to shed at its own pace as it is different for every skin type. You may use small precise scissors (can also be called eyebrow scissors or cosmetology scissors) to gently snip the dead skin that has peeled.

Best Described Skin Type

What are your skin care goals?

Had chemical peel, laser or microdermabrasion before?

yesno

Do you exfoliate?

yesnosometimes

I have read and filled out the information above. If I have any concerns I will address these to my Esthetician immediately. I give my Esthetician permission to perform any facial treatments and will hold her and her staff harmless from any liability that may result from treatments. I also, to my best knowledge, have given an accurate account of my medical history, including all known allergies or prescription drugs or products I'm currently ingesting or using topically. I understand my Esthetician will take every precaution to minimize or eliminate any negative reaction as much as possible. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I understand that this document is to provide the best possible guest experience when receiving any treatment from a Corrective Skincare Licensed Esthetician.*

by checking this box I understand and accept this statement.

Signature*

Corrective Skincare Treatment Consent Form: