Self Assessment
Choose Consent Form
hydrafacial consent form english
File Number:
HydraFacial Consent Form
Terms and Conditions:
• Your skin may experience temporary irritation, tightness, or redness.
• You may experience tingling and stinging in the treatment area.
• Client experiences may vary.
• You will likely see results immediately after treatment and your skin may feel smooth and hydrated
• Avoid excessive sun exposure and use a SPF sunscreen.
• 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 pre-and post-treatment.
• Any contraindications will void this treatment
• This treatment cannot be transferred to another person
• Once the machine has been turned on, refunds are prohibited
• Appointments preferences are based on machines availability
I am a competent consenting adult of at least 18 years of age (or my parent or legal guardian is giving consent on my behalf), and further:
• Pre and post treatment instructions have been explained to me
• Have had the opportunity to ask questions, and all of my questions have been answered to my satisfaction
• Must notify the clinician if my medical history changes prior to subsequent treatments
• I consent to clinical photographs being taken of my treated areas for my personal health record only
• My signature below constitutes my acknowledgment and understanding of all this information
Patient Name
Patient Signature
DATE/Time
Parent or Guardian (if patient is minor)
WITNESS
Patient Signature
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