DERMAPLANING WAIVER

Dermaplaning Waiver
Your privacy is important to me. The information you provide on this form is strictly confidential and will be used solely for consultation and service purposes within my practice.

All records are kept secure and will not be shared with anyone outside of Glow Skin Studio without your written consent.

Dermaplaning is a gentle exfoliation treatment that helps smooth the skin, remove peach fuzz and enhance overall radiance. While dermaplaning is considered safe for most skin types, individual skin responses may vary. This waiver provides important information regarding the treatment process, potential risks, contraindications and proper pre- and post-care to ensure the best possible results and your safety.

Sections marked with asterisk (*) are required and cannot be bypassed
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Have you had a dermaplaning before?

YesNo
If so, when was your last treatment?
Medical History
Please review and indicate if any of the following apply to you now or within the past 6–12 months. Check all that apply

Active acne or cystic acneEczema, psoriasis, or dermatitisOpen wounds, cuts, or lesionsPregnancyActive cold sores, herpes simplex, or wartsRecent chemical peel, laser, or microneedling (within last 2–4 weeks)History of keloid scarring or poor wound healingRecent sunburnRosacea or very sensitive skinSkin cancer or suspicious lesionsUse of Accutane within the past 6–12 monthsUse of Retin-A, Tretinoin, or similar products within the last 5–7 daysOther medical or skin conditions (please indicate below)
Other:
Important Clauses
I understand that dermaplaning is generally painless; however, you may experience sensations such as (but not limited to):

- Temporary redness, sensitivity, or irritation
- Minor nicks or superficial cuts
- Allergic reaction to products used during or after treatment
- Breakouts or purging
- Infection if aftercare instructions are not followed
I acknowledge that results vary from person to person and no guarantees have been made regarding specific outcomes.*

I Agree
I understand this procedure removes most, not all vellus hair (peach fuzz)*

I Agree
I understand that direct sun exposure, including tanning beds, is not recommended while undergoing treatment and the use of a daily sun block protection is mandatory*

I Agree
I confirm that:

I have avoided exfoliating treatments, waxing, laser treatments, or chemical peels prior to this service as instructed.

I will follow all post-treatment instructions provided, including sun protection and avoiding active products for the recommended timeframe.

I understand that failure to follow aftercare instructions may increase the risk of adverse effects.
I understand that dermaplaning does not change the color, thickness, or rate of hair regrowth. Hair will grow back naturally as it was prior to treatment.*

I Agree
Are you comfortable with photos or videos being taken/recorded during your treatment with the content potentially being used for marketing (social media, website, promotions or advertising) or just for private use (your files, progress photos)?*

Yes, for all of the aboveYes, only for my files or progress onlyNo, prefer my treatment kept privateNo preference
Terms & Conditions
I voluntarily consent to receive dermaplaning services. I acknowledge that I have had the opportunity to ask questions and that all of my questions have been answered to my satisfaction.

I hereby release and hold harmless the service provider, business, employees and affiliates from any and all liability, claims, demands, or causes of action arising from this treatment, except in cases of gross negligence.

I understand that I may withdraw my consent at any time before or during the treatment.
By signing below, you acknowledge the terms & conditions outlined on this form.
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Dermaplaning Waiver

Medical History

Important Clauses

Terms & Conditions