Peel and Pen Consent
Peels
I understand that a Chemical Peel is a solution that harnesses the body’s natural processes of renewal, causing the skin to peel, allowing new skin to grow in its place and that this treatment is used for a variety of skin conditions of which I hereby consent to be a client receiving the Chemical Peel treatment on the specified area above for the specified concern.
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I understand that clinical results may vary depending on individual factors, including medical history, skin type, client compliance with pre/post treatment instructions and individual response to treatments.
I confirm that I have informed the staff regarding any current or past medical condition, disease or medication taken and that the list of contraindications has been fully explained to me. I also undertake to inform the staff of any changes to my medical condition or medication taken during the course of my treatment or any further future treatments.
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I understand that there is a possibility of temporary Short-Term Effects which have been fully explained to me and that I will inform the staff of any adverse reactions within 24 hours of them occurring:
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Swelling and puffiness may occur after 24-72 hours.
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Redness after 72 hours could indicate irritation or allergy to an ingredient.
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Itching can occur- oral anti-histamine can be taken.
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Post inflammatory hyperpigmentation (PIH) can occur - Corrective Brighter Concentrate and Ovelle Supplement will minimize this risk.
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Underlying congestion can be brought to the surface- whiteheads, blackheads and pustules can occur.
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NB: For darker skin types, the skin will darken further before shedding.
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Note, pigmentation may worsen after the first few peels as it’s brought closer to the surface of the skin – therefore a course of peels is suggested.
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I have been fully informed and understand:
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The treatment involves a series of sessions which need to be continued at set intervals dependent on the nature of the concern – failure to adhere will result in a less desired outcome
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The nature and purpose of the treatments
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Expected outcomes and possible short-term effects
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The final result obtained cannot be guaranteed
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The fee structure including the payment terms and conditions
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The late arrival, no-show and cancellation policies
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My condition is of cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so.
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I confirm and understand that the Pre-Treatment Protocols have been fully explained to me and are important and advisable for the desired outcome and that I undertake to / have adhered to these requirements prior to my treatment.
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I confirm and understand that the Post-Treatment Protocols have been fully explained to me and I will adhere to these requirements after my treatment. I also acknowledge and understand that Maintenance and additional Home Care Routines are advisable for effective and long-lasting results.
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I understand the importance of Before and After Photographs and consent to the following:
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The taking of my before and after photographs
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Authorize their anonymous use for the purposes of medical audit, education and promotion.
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Dermapen Microneedling
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I understand that Dermapen™ Microneedling is an approved treatment, designed to create a safe healing response within the body, through the use of surgical microneedles that puncture pinpoint microchannels in the body, igniting natural collagen and elastin production from within the skin and is used for anti-aging, rejuvenation, pigmentation and skin texture of which I hereby consent to be a client receiving the Dermapen™ Microneedling treatment on the specified area above for the specified concern.
I understand that clinical results may vary depending on individual factors, including medical history, skin type, client compliance with pre/post treatment instructions and individual response to treatments.
I confirm that I have informed the staff regarding any current or past medical condition, disease or medication taken and that the list of contraindications has been fully explained to me. I also undertake to inform the staff of any changes to my medical condition or medication taken during the course of my treatment or any further future treatments.
I understand that there is a possibility of temporary Short-Term Effects which have been fully explained to me and that I will inform the staff of any adverse reactions within 24 hours of them occurring:
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Swelling, rash-like effect and prolonged redness
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Sensitivity and stinging for more than 5 days
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Possible post inflammatory hyper-pigmentation (PIH) due to unprotected sun exposure
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Mild bruising
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Infection
I have been fully informed and understand:
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The treatment involves a series of sessions which need to be continued at set intervals dependent on the nature of the concern – failure to adhere will result in a less desired outcome
-
The nature and purpose of the treatments
-
Expected outcomes and possible short-term effects
-
The final result obtained cannot be guaranteed
-
The fee structure including the payment terms and conditions
-
The late arrival, no-show and cancellation policies
-
My condition is of cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so.
I confirm and understand that the Pre-Treatment Protocols have been fully explained to me and are important and advisable for the desired outcome and that I undertake to / have adhered to these requirements prior to my treatment.
I confirm and understand that the Post-Treatment Protocols have been fully explained to me and I will adhere to these requirements after my treatment. I also acknowledge and understand that Maintenance and additional Home Care Routines are advisable for effective and long-lasting results.
I understand the importance of Before and After Photographs and consent to the following:
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The taking of my before and after photographs
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Authorize their anonymous use for the purposes of medical audit, education and promotion
I have read and fully understand the contents of this consent form.
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