Dermaplaning consultation form

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I understand that Dermaplaning involves the use of a sterilized surgical blade to remove fine vellus hair from the face, and provide light exfoliation

DERMAPLAINING CONTRAINDICATIONS: means anything (including a symptom or medical condition) that is a reason for a person not receive a particular treatment or procedure because it may be harmful. Although it is impossible to list every potential risk and complications, the following conditions are recognized as contraindications for Dermaplaining treatment and must be disclosed prior to treatment. Active Acne, Active Infection of any type, such as Herpes Simplex or Flat Warts, Any Raised Lesions Any certain Peel Procedure (Can ONLY apply after dermaplane facial) If not you will have to wait 7 days after to get dermaplaining , Chemotherapy or Radiation, Eczema or Dermatitis, family history of Hypertrophic Scarring or Keloid formation, Hemophilia Hormonal therapy that produces thick Pigmentation, Moles, oral Blood Thinner medications Recent use of topical agents such as Glycolic Acids, Alpha Hydroxy Acids and Retin-A, Rosacea type 1 is ok (mild) Scleroderma, Skin cancer, Sunburn, Telangiectasia/ Erythema may worsened or brought out by exfoliation- you will be red thick dark Facial Hair (It can cause ingrown and get stuck (Recommended Lasor treatment) We remove vellus hair ONLY Uncontrolled diabetes, use of Accutane within the last year Vascular lesions. 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 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, nicks to the skin can occur due to the sharp surgical blade. The hair that grows back will not be darker or thicker, however I do understand that any hormone imbalance present within my anatomical system can alter the normal hair growth pattern.

If an enzyme or chemical peel is included with this treatment, I understand that the sensation and penetration of the peel 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 virus is already present in the body. I certify that I have read this entire consent form and I understand and agree to the information provided in this form. I certify that I am at least 18 years of age, or I have a parental consent co-signed below. I will call to inform my aesthetician of any complications or concerns as soon as they occur. I certify that I have read the above consent and I fully understand it and give my consent to the Dermaplaning treatment. POST TREATMENT CARE: Aerobic exercise or vigorous physical activity should be avoided until all redness has subsided. Direct sunlight exposure is to be completely avoided immediately following the treatment (including any strong UV light exposure or tanning beds). Although SPF 30+ should already be a part of your daily skin care, after dermaplaining, SPF 30+ must be applied daily to the treated area for a minimum of two weeks. Twice daily cleanse the treated area with a post-treated cleanser, followed by a serum or treatment cream and follow with SPF 30+ sunscreen.

I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. The treatments I receive here are voluntary and I release the skin care professional from liability and assume full responsibility thereof. I understand and voluntarily accept the risks associated with all services. I agree that this waiver is in effect for all services, and will not expire unless specifically requested by either party. By signing this form, I agree to the above terms, authorizing the skin care professional to retain my personal information on my private client account, and release the skin care professional from any liability or claims. Please print your name in the box and sign your signature below. Thank you.

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Dermaplaning Consulation & Consent Form