Microdermabrasion Aftercare Instructions Acknowledgment Form
Please review and acknowledge your understanding of the aftercare instructions for your microdermabrasion treatment.
Client Full Name
*
First Name
Last Name
Contact Phone or Email
*
Service Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Treatment Provider / Staff Name
*
Have you received and reviewed the microdermabrasion aftercare instructions?
*
Yes
No
Key Aftercare Instructions Reviewed (please check all that apply)
*
Keep skin clean and moisturized
Avoid touching or picking at treated area
Apply sunscreen daily
Avoid hot showers, saunas, and steam rooms
Avoid makeup for at least 24 hours
Other
How long should you avoid sun exposure after treatment?
*
Please Select
24 hours
48 hours
72 hours
One week
Other
How long should you avoid exfoliants and retinoids after treatment?
*
Please Select
3 days
5 days
One week
Two weeks
Other
Questions or Concerns
Submit Acknowledgment
Should be Empty: