HydraFacial Consent Form Logo
  • 3141 E Broad St Suite 303 Room 114, Mansfield, TX 76063
    (682) 213-0798
    lealux.glossgenius.com

  • HydraFacial Consent Form

  • Client Details

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  • Treatment Information

  • What is HydraFacial?

    HydraFacial is a hydradermabrasion procedure that combines cleansing, exfoliation, extraction, hydration, and antioxidant protection simultaneously resulting in clearer, more beautiful skin with little to no downtime. The treatment is soothing, moisturizing, non-invasive and generally non-irritating. As with most procedures, visible results from HydraFacial will vary from person to person.

    What to expect

    • Your skin may experience temporary irritation, tightness, or redness. These are all normal reactions that typically resolve within 72 hours depending on skin sensitivity.
    • You may experience tingling and stinging in the treatment area. These sensations generally subside within a few hours.
    • Client experiences may vary. Some clients may experience a delayed onset of these symptoms.
    • You will likely see results immediately after treatment and your skin may feel smooth and hydrated for one to four weeks with appropriate home care to maintain treatment results.
    • The skin is more susceptible to sunburn/sun damage. Avoid excessive sun exposure and use a minimum of SPF 30 sunscreen.
  • Medical Information

    Do you have any of the following conditions?
  • Pre-Treatment Guidance

    • Don’t use any exfoliating treatments, like glycolic acid or enzymes, on the area that is going to be treated for at least 48 hours before your treatment.
    • Stop using any medium or deep chemical peels or chemical resurfacing treatments and laser treatments for at least 2 weeks before you have this facial treatment.
    • Do not wax or use depilatories for at least 48 hours before your treatment.
    • Stop using any over-the-counter acne medications, like benzoyl peroxide and salicylic acid, for at least 48 hours before you have your facial.
    • Avoid any excessive sun exposure and do not use any tanning beds for at least 72 hours before treatment.
    • Do not have any Botox treatments for at least 2 weeks before treatment. You can have Botox done on the same day as your facial, but it must happen after the facial.
    • Do not shave your face on the same day as the facial treatment.
  • Post-Treatment Guidance

    • Avoid extra sun exposure and don’t use any tanning beds for at least 72 hours after the treatment.
    • Apply minimum SPF 30 sunscreen daily for at least 5 days after the treatment.
    • Avoid touching your face for 24 hours after the treatment. The morning after the treatment you may wash your face with a very gentle cleanser.
    • Don’t use topical Retin-A or generic tretinoin for at least 48 hours after treatment.
    • Do not wax or use depilatories for at least 48 hours after the treatment.
    • Don’t use any medium or deep chemical peels or laser treatments for at least 2 weeks after your facial treatment.
    • Don’t use any exfoliating treatments, like glycolic acid or enzymes, for at least 48 hours after the treatment.
    • Don’t use over-the-counter acne medications, like benzoyl peroxide or salicylic acid, for at least 48 hours after treatment.
    • Avoid intense heat (e.g. hot bath/shower, exercise, sauna etc.) for at least 48 hours after treatment.
    • Wait 24 hours before applying makeup. When you do apply makeup ensure your brushes have been thoroughly cleansed to avoid infection.
  • Consent

    Please check each box to show your understanding and agreement.
  • Signature

    This agreement will remain in effect for this procedure and all future HydaFacial procedures. I will alert the skincare specialist if there are any future changes to my medical history. I have read and fully understand all information in this agreement. I am over 18 years of age and consent to the agreement and to the HydraFacial procedure.
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