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hydrafacial keravive treatment
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HYDRAFACIAL KERAVIVE TREATMENT CONSENT FORM
Hydrafacial keravive is a unique, relaxing treatment designed to cleanse, stimulate, nourish and hydrate the scalp for fuller and healthier looking hair. As with most results from hydrafacial kerative will vary from person to person.
• Advise client to take shower, hair must be clean and dry before the keravive treatment.
• Scalp may experience temporary irritation, tightness or redness. This is all normal reactions that typically resolve within 72hrs depending on the scalp sensitivity.
• You may experience tingling in the treatment area. This sensation generally subsides within few hours.
• Client experiences may vary. Some clients may experience a delayed onset of symptoms.
• The combination of cleansing, exfoliation and hydration and daily use of take home spray improves circulation and nourishes hair follicles for thicker, shinier and healthier looking hair.
• Avoid excessive sun exposure and use a minimum SPF sunscreen. The scalp can be susceptible to sun damage.
• It is recommended to have the hydrafacial keravive treatment ONCE A MONTH AND 3 CONSECUTIVE MONTHS with continuous daily use of the take home spray throughout.
I am a competent consenting adult of at least 18 years old 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 have.
• 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 acknowledgement 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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