Dermaplaning Consent Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail* Dermaplaning is a form of manual exfoliation similar in theory to microdermabrasion but without the use of suction or abrasive crystals. An esthetician grade, sterile blade is stroked along the skin at an angle to fently "shave off" dead skin cells from the epidermis. Dermaplaning also temporarily removes the fine vellus hair of the face, leaving a very smooth surface.Please read and check the box once you understand each statement. Consent Checkoff* Due to contours of the face, certain areas of the face (such as eyelids and nose) are not treatable using this method. If dermaplaning is not appropriate, you will be informed during this session and an alternative treatment may be recommended instead. If dermaplaning is not contraindicated, maximum results are obtained by participating in a series of treatments plus following a home care regimen. You may experience redness, dryness, or even some peeling between sessions, which may or may not be normal. Dermaplaning may cause minor superficial abrasions which may not appear until a day or two following your treatment. If this should occur, please contact me so that I can do a post-treatment follow up with you. After your treatment, SPF 30+ MUST be worn at all times. Tanning beds should never be used. Clients receive noticeable, satisfactory to above average results with a series of treatments and a commitment to a daily skin care regimen. However, the outcome cannot be guaranteed as maximum results are hight dependent on age, cumulative sun exposure, health, lifestyle, genetic traits, general skin condition, and willingness to follow recommended protocols. Aerobic exercise or vigorous physical activity should be avoided until all redness has subsided. SPF 30+ must be applied daily to the treated area for a minimum of two weeks. Twice daily cleanse the treated area with post-treatment cleanser, followed by a serum or treatment cream and follow with SPF 30+ sunscreen. The following conditions are recognized as contraindications for dermaplaning treatments and must be disclosed prior to treatment. Check all that may apply to you: Conditions Active acne Active infection of any time Any raised lesions Any recent chemical peel procedures Chemotherapy or radiation Eczema or Dermatitis Hemophilia Hormonal therapy that produces thick pigmentation Moles Oral blood thinner medications Pregnancy Use of Glycolic acids, Alpha-hydroxy acids and Retin-A Rosacea Scleroderma Skin cancer Sunburn Tattoos Thick, dark facial hair Uncontrolled diabetes Use of Accutane within the last year Vasular lesions I hereby agree to all of the above and agree to have this treatment performed on me. I further agree to follow all post-care instructions. Prior to receiving any treatment, I have been candid in revealing any condition that may have bearing on this procedure.Signature* Reset signature Signature locked. Reset to sign again Date* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
