• HydraFacial™ Treatment Consent Form

    Please review the information below and indicate any relevant conditions or recent treatments. Complete all sections and sign at the end to provide your consent.

  • HydraFacial is the only 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 possible temporary 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 40 sunscreen.

  • Do you have any of the following?

  • Active acne or infection*
  • Open lesion or cold sore*
  • Active sunburn*
  • Skin conditions such as eczema, dermatitis, or rashes*
  • An autoimmune disease such as lupus*
  • A viral concern such as HIV or hepatitis*
  • Anticoagulants Therapy*
  • Melanoma or lesions suspected of malignancy*
  • Pregnancy or lactation *Please note if you are pregnant/nursing you should consult with your OBGYN- the HF contains salicylic acid which some Dr's are ok with and others prefer you to wait.*
  • Neurological disorders such as epilepsy (LED Lights)*
  • Infection in the urinary system i.e. kidneys, bladder and urethra (Lymphatic drainage)*
  • Crohn’s Disease (Lymphatic drainage)*
  • Hyperthyroidism (Lymphatic drainage)*
  • Deep Venous Thrombosis (Lymphatic drainage)*
  • Lymphedema (Lymphatic drainage)*

  • Have you recently?

  • Are you currently using or have used Accutane, topical medications, retinol or antibiotics?*
  • Had aesthetic fillers, injectables or laser treatments*
  • Date of appt *
     - -
    2 digit month, 2 digit day, 4 digit year

  • By signing below, I confirm that I have read and understand the information provided regarding my HydraFacial treatment. I certify that the information I have provided is complete and accurate and that I have disclosed all known medical conditions, medications, allergies, skin conditions, and recent treatments that may affect my treatment.

    I understand that individual results vary and that no specific results are guaranteed. I understand that possible reactions may include, but are not limited to, temporary redness, irritation, sensitivity, tightness, dryness, tingling, stinging, breakouts, swelling, or other skin reactions.

    I voluntarily consent to receive the HydraFacial treatment and authorize my provider at Knockout Beauty Bar/ Knockout lashes & skin and any employee to perform the treatment. I acknowledge and accept the known and reasonably foreseeable risks associated with the treatment and agree to follow all recommended pre- and post-treatment instructions.

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