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    Hydrafacial Official Consent

    Uploaded by

    Onur
    This document outlines the informed consent process for a HydraFacial treatment. It describes the HydraFacial procedure, possible side effects such as redness or tingling, expected results including smoother skin for 1-4 weeks, and contraindications like autoimmune diseases, infections, or sunburn. It requests information about medical history and recent treatments. Finally, it acknowledges risks and gives consent for treatment, future treatments, and potential photo documentation.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Hydrafacial Official Consent

    Uploaded by

    Onur
    244 views2 pages
    This document outlines the informed consent process for a HydraFacial treatment. It describes the HydraFacial procedure, possible side effects such as redness or tingling, expected results including smoother skin for 1-4 weeks, and contraindications like autoimmune diseases, infections, or sunburn. It requests information about medical history and recent treatments. Finally, it acknowledges risks and gives consent for treatment, future treatments, and potential photo documentation.

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    This document outlines the informed consent process for a HydraFacial treatment. It describes the HydraFacial procedure, possible side effects such as redness or tingling, expected results including smoother skin for 1-4 weeks, and contraindications like autoimmune diseases, infections, or sunburn. It requests information about medical history and recent treatments. Finally, it acknowledges risks and gives consent for treatment, future treatments, and potential photo documentation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    244 views2 pages

    Hydrafacial Official Consent

    Uploaded by

    Onur
    This document outlines the informed consent process for a HydraFacial treatment. It describes the HydraFacial procedure, possible side effects such as redness or tingling, expected results including smoother skin for 1-4 weeks, and contraindications like autoimmune diseases, infections, or sunburn. It requests information about medical history and recent treatments. Finally, it acknowledges risks and gives consent for treatment, future treatments, and potential photo documentation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Informed Consent Form for HydraFacial

    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 all
    normal 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
    symptoms.
     You will likely see results immediately after treatment and your skin may feel
    smooth and hydrated for one to four weeks.
     The skin is more susceptible to sunburn/sun damage. Avoid excessive sun
    exposure and use a minimum of SPF 30 sunscreen.

    Do you have any of the following?

     An autoimmune disease such as HIV, lupus, hepatitis, scleroderma


     Skin conditions such as eczema, dermatitis, or rashes
     An active infection in the treatment area
     Melanoma or lesions suspected of malignancy
     Active sunburn
     Pregnancy or lactation
     Anticoagulants Therapy
     Neurological disorders such as epilepsy
     Infection in the urinary system including kidneys, bladder and urethra
     Crohn’s Disease
     Hyperthyroidism
     Deep Venous Thrombosis
     Lymphedema
     Open lesion
     Active Acne/Inflammatory Acne

    Have you recently?

     Used Accutane or similar medication Yes No


     Had aesthetic fillers, injectables or laser treatments Yes No

    I acknowledge the following:

     I will avoid the use of aggressive exfoliation, waxing, and products containing
    acids that are not part of the recommended take-home regimen in the treated
    areas for minimum 2 weeks pre-and post-treatment.
     Photos may be taken before, during and after the HydraFacial treatment. Photos
    will only be used with my written approval for education, promotion or
    advertising purposes.
     The information provided has been explained to me and all my questions have
    been answered to my satisfaction. I have read the above information, and I give
    my consent to have the HydraFacial treatment by the staff at .
     By signing below, I acknowledge that I have read the above information and
    give my consent to be treated with the HydraFacial System. This consent form Is
    valid for all future HydraFacial treatments. I will alert the staff If there are any
    future changes to my medical history.

    - Patient name & signature:

    - Date:

    - Therapist name & signature:

    - Witness name & signature:

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