PLEASE ANSWER THE FOLLOWING QUESTIONS SO THAT I MAY HAVE A BETTER UNDERSTANDING OF YOUR GENERAL HEALTH AND CONCERNS, THERBY ENABLING ME TO ACCURATELY ANALYZE AND ASSES YOUT SKIN CARE NEEDS.
SPA POLICY: If you no-show or cancel your appoitment the same day as your scheduled service, you will be charged a $25 fee asssed to the card on file.
Any service under $50 will be charged 50% of the scheduled service assesed to the card on file.
PRODUCT RETURN POLICY: Product returns will be accepted up to 7 days of purchase, with a 20% restocking fee assesed to the refund or exchange.
FACIAL SERVICE &TREATMENT INFORMED CONSENT
Please read and initial after each paragraph.
You have the right to be informed about your skin peeling treatment.I have been given the Skin History Questionnaire and have read and answered the questions thoroughly. I have discussed any further questions that I may have with my skin care specialist.I am aware and acknowledge that there is a rare possibility of an allergic reaction. I have discussed thoroughly with my skin care specialist any such reactions and understand them. I have had a patch test and it is negative.I am willing to forego a patch test but understand there could be an allergic response.I have been advised that my treatment is a noninvasive, light epidermal exfoliation consisting of any of the following: salicylic acid, AHAs, retinol, TCA, resorcinol, or red wine vinegar acid.These are superficial procedures. The use of the above ingredients stimulates the skin to generate new skin cells and new collagen formation and increases the blood circulation and flow to the skin. It does not replace deep chemical peels, laser resurfacing or plastic surgery.I acknowledge that during application I will notice a warm sensation and the skin may tingle, sting or burn. Immediately after the peel, my face may appear frosted or sunburned, and by day two, the skin may darken in color, feel tighter, and be more sensitive. Days two through seven, the skin will peel. I am not to pick or peel the old skin. Pulling or picking skin may lead to infection (which will require treatment with topical antibiotic) or surface scarring. I may experience some breaking out after a peel.I acknowledge that I will avoid direct sun exposure and tanning beds during this procedure and will apply sunscreen daily.Skin peels may lighten hyperpigmented skin, and I acknowledge that there is NO GUARANTEE that dark discoloration of the skin known as melasma will be reduced or faded. I am aware that there could even be an increase in uneven color from this procedure. I acknowledge that I have not been on Accutane during the past six months.I acknowledge that I have not been using Retin A or Renova for the past two weeks.I acknowledge that if I am prone to cold sores (herpes), I may need a prescription from my physician prior to having the peel. I am aware the treatment could bring about cold sores.I acknowledge that I am not aspirin-sensitive or, if I am, I have discussed this with my skin care specialist and understand that there could be a reaction.I acknowledge that I will not have any other skin care procedures of any sort until I am passed by my skin care specialist to do so.
I acknowledge that I have not used Accutane or any medication for the same purpose during the last 12 months.
I acknowledge that if I have ever had a cold sore or fever blisters, I should consult with my physician or pharmacist for a pre-use medication to help avoid a possible breakout. That medication should be used each day for two days before, same day, and two days after any aggressive facial exfoliation treatment.
I acknowledge that there is no guarantee that the dark discoloration of skin will be reduced or fade. Pigmentation may improve or darken with successive treatments. I acknowledge the need for proper skin care home regimen.
I acknowledge that my skin might experience temporary irritation, tightness, redness or slight swelling which usually dissipates within 72 hours depending on skin sensitivity.
I have disclosed my history of allergies above.
I acknowledge that if I am allergic to one or more of the ingredients in the products used, I may experience allergic reactions.
I acknowledge that if I fail to use a minimal sunscreen (SPF 30) and follow the direction for use, I am more susceptible to sunburn, sun damage & hyper-pigmentation. I should avoid excessive sun
exposure, especially between 10 am - 2 pm.
I acknowledge that this treatment is strictly an elective cosmetic procedure and that no medical claims have been expressed or implied.
I acknowledge that I should avoid the use of aggressive exfoliation, waxing, and products containing acids that are not part of the recommended take-home regimen for 2-4 weeks following the treatment.
I acknowledge that I should avoid the use of Retin-A type products for a period of time recommended by my physician and/or skincare practitioner during and following the treatment.
I understand that Dermaplaning involves the use of a surgical blade to remove dead skin along with light exfoliation.
I understand that the treatment may involve the risk of complication or injury and I freely assume those risks. Possible side effects of the treatment area can include mild redness of the skin, irritation, and dryness. Additionally, nicks to the skin can occur due to the sharp surgical blade. The hair that grows back will not be darker or thicker, however, I do understand that any hormonal imbalance that may be present within my anatomical system can alter the normal hair growth pattern.
I hereby agree to have the treatment performed and agree to follow all pre and post-treatment instructions.
I acknowledge that I have answered all questions truthfully and completely.
I release Morgan Schimmel, WAX LASH & BEYOND LLC, management and staff from any and all liability associated with any injuries and/or current or future conditions resulting from the skin care procedures or products.
I consent to the use of my before, during and after facial procedure photographs for education, promotion or advertising purposes. My name will not be used to identify these photographs without my written approval.
By signing below, I certify that I have read and fully understood the contents of this consent form and that the information I provided above is complete, accurate, and up-to-date to my knowledge.