Consent For Hydrafacial

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Last 4 Digits Of IC Number

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 these symptoms
You will likely see results immediately after treatment and your skin may feel smooth and hydrated for one to four weeks with appropriate home care to maintain treatment results
The skin is more susceptible to sunburn/sun damage. Avoid excessive sun exposure and use a minimum of SPF 40 sunscreen

Do You Have Any Of The Following?

Active Acne Or Infection
Open Leision Or Cold Sore
An Active Infection On Treatment Area
Active Sunburn
Skin Conditions , such as ezcema dermatitis , rashes
A viral concern , such as HIV or Hepatitis
Pregnancy Or Lactation
Neurological disorders such as epilepsy (LED Lights)
Anticoagulants Therapy
An autoimmune disease such as lupus
Melanoma or lesions suspected of malignancy
Infection in the urinary system i.e. kidneys, bladder and urethra (Lymphatic drainage)
Crohn’s Disease (Lymphatic drainage)
Hyperthyroidism (Lymphatic drainage)
Lymphedema (Lymphatic drainage)

I Acknowledge The Following

I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols that are not part of the recommended take-home regimen in the treated areas for minimum 2 weeks preand 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 treatmen
By submitting this, 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

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