• Microdermabrasion Consent Form

    Microdermabrasion Consent Form

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  • Format: (000) 000-0000.
  • Consent

  • DEFINITION: Microdermabrasion is a treatment procedure that is used in order to clean and remove the dead surface skin cells which improve the skin quality and promote skin healing.

    AUTHORIZATION: I authorize this beauty clinic to perform this treatment called Microdermabrasion on my skin.

    GUARANTEE: I understand that this procedure does not guarantee any results and each individual has their own treatment outcome. We can continue the treatment until the expected result comes out.

    INSTRUCTIONS: I confirm that I understand the instructions provided to me by the therapist. I will follow the post-care instructions in order to prevent any complications or negative outcomes. This include:

    • Use sunblock daily with an SPF 30
    • Avoid swimming and tanning
    • Avoid using facial scrubs 24-48 hours after treatment
    • Only use a mild cleanser

    CONTRAINDICATIONS: I understand that this procedure has contraindications which means that it is recommended not to proceed with the treatment if you have the following:

    • Active acne
    • Sunburn
    • Eczema
    • Dermatitis
    • Skin Cancer
    • Tattoos
    • Permanent Make up
    • Pregnancy and breastfeeding
    • Undergoes hair waxing or hair removal
    • Infection like Herpes Simplex Virus
    • Diabetes
    • Undergoes any chemical peeling
  • Do you have any of the following contraindications listed above?
  • PHOTO CONSENT: Do you allow or permit this clinic to take photos of your face for marketing purposes? This includes banners, tarpaulin, websites, and social media.
  • RELEASE: I release the clinic and the therapist and hold them harmless from any liability that might happen during and after the treatment.

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