Skin Treatment Consultation and Consent Form

MEDICAL HISTORY

MEDICATION

PREVIOUS SKIN TREATMENT HISTORY

REASON(S) FOR TREATMENT

CONSENT FORM

• I have answered all the questions regarding my health and skin correctly and to the best of my knowledge, as I am aware that some ailments and medication can affect healing of the skin and it is my responsibility to ensure that I inform my therapist if I begin a course of medication.    
• The cost of treatment has been advised and the specific treatment parameters have been discussed and established. 
• I understand the prices quoted. 
• I understand that sun exposure and sun beds on the treatment area are not permitted during my treatment, and application of SPF 30 plus must be used if exposure is unavoidable. 
• I understand that I should avoid exfoliating for 30 days post Dermaplaning treatment. 
• I understand that I should not use Retinol for 48 hours pre and post treatment. It is my responsibility to advise my therapist of any exposure to the sun or sun bed before and during the treatment course. 
• I understand that failure to do so could have an adverse effect on my skin.
• I am aware that no waxing should be done 48 hours pre and post treatment. 
• I know to avoid excessive heat for 48 hours after treatment. 
• I am aware not to wear heavy makeup immediately after my treatment. I am aware not to excessively touch or pick my skin. 

• I hereby accept that the essential information necessary to make an informed decision has been given to me.       
• I have been fully informed of the risks that may be associated and have had the opportunity to ask questions relating to the procedure I am about to undergo.
• I understand that no warranty or guarantee has been made to me as a result or cure. It is possible that results might not come up to expectations or goals. We will not be held financially liable provided treatments have been carried out in good faith. 

Data Protection and Privacy

We are committed to protecting your privacy. We take special precautions with your sensitive personal data and we will process your data lawfully and as described. We only process the data we need for as long as we need to and we respect all of your rights under GDPR. We will never sell, share or otherwise abuse your data. You can contact us at anytime to request your data, change your preferences or request that your data be deleted. GDPR is the European privacy law designed to protect you and give you control of your data.

Treatment Record

1 - White, very fair, red or blond hair, usually blue eyes, freckles - Always burns in sunlight, never tans.

2 - White Caucasian skin, fair, red or blond hair (can be light/medium brown) blue, hazel, green eyes (known as Celtic skin)  - Usually burns, tans with difficulty.

3 - Caucasian skin, can be slightly darker or extreme light Asian. Eye colour varies – known as European skin - Sometimes burns, usually tans when exposed to UV.

4 - Brown, Mediterranean, Hispanic skin. Light to medium Asian tone with dark eyes and dark hair - Rarely burns when exposed to UV, Tans easily.

5 - Darker skin – middle eastern , dark Asian, Latin American/ Indian Skin - Very sensitive to UV, tans very easily.

6 - Black, Afro Caribbean skin, very dark - Very sensitive to UV, darker pigment after exposure. 

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