Dermaplaning Consent Form

Dermaplaning Consent Form

Celestial Beauty, LLC, 18 SW Front St. Suite 108, Milford, DE 19963, celestial beauty.de@gmail.com, 302-362-5611
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Understanding the Procedure:
Dermaplaning is a skin exfoliation treatment that uses a sterile surgical blade to gently remove dead skin cells and fine vellus hair (“peach fuzz”) from the face. The result is smoother, brighter skin.

Benefits:
- Enhanced skin texture and glow.
- Improved absorption of skincare products.
- Flawless makeup application.
Possible Risks:
- Redness, sensitivity, or irritation.
- Minor nicks or scratches.
- Breakouts or flaking.
- Skin infection (rare with proper aftercare).
Health Questionnaire

Please disclose any conditions that may affect the procedure:
Do you have sensitive skin?*

YesNo
Have you used Accutane in the past six months?*

YesNo
Are you currently using retinoids, glycolic acid, or exfoliating products*

YesNo
Do you have a history of cold sores or herpes simplex?*

YesNo
Have you undergone recent facial treatments (e.g., chemical peels, microdermabrasion)?*

YesNo
If yes, please specify:
Any known allergies or skin sensitivities?*

YesNo
If yes, please specify:
Before Your Appointment:
- Arrive with clean, makeup-free skin.
- Avoid using exfoliating products or active ingredients (e.g., retinoids) 48 hours before your appointment.
- Inform your provider of any new medications or treatments.
Aftercare Instructions:
- Avoid sun exposure and wear SPF 30+ daily.
- Avoid active skincare products (retinoids, AHAs, BHAs) for 72 hours.
- Moisturize and hydrate regularly.
- Do not touch or pick at your face.
Acknowledgment and Release:
I hereby grant permission for Celestial Beauty, LLC to take before-and-after photographs of my treatment area. I understand that these photos may be used for:
- Personal client records (confidential use only).
- Marketing and promotional purposes, including social media and website content.
Photography Consent*
Client Signature

By signing this form, I acknowledge that I have been informed of the nature, purpose, and risks of dermaplaning. I understand that results may vary based on individual skin types and conditions. I release Celestial Beauty, LLC and its representatives from any liability related to adverse reactions that may occur as a result of the procedure, provided that all guidelines and instructions are followed.
Client Signature:

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Dermaplaning Consent Form

Health Questionnaire

Before Your Appointment:

Aftercare Instructions:

Acknowledgment and Release:

Client Signature