Dermalux Consent Form (Remote) | Webform Portal

Dermalux Consent Form

Title *

Gender *

Female Male

First Name *

Surname *

Address *

Postcode *

Telephone *

Email *

D.O.B *

Client Consent

I confirm that I have answered all the questions to the best of my knowledge and understand that withholding necessary information about my health and medication may increase my risk of possible side effects.

I will inform my practitioner before every treatment if there has been any change to my circumstances or medication I may be taking.

I understand that the Dermalux systems have not been tested on pregnant women and therefore the risk to the foetus or pregnant woman is unknown.

I understand the benefits and likely clinical outcome of the Dermalux treatment and that multiple treatments are necessary to achieve optimal results.

I acknowledge that no written or implied verbal guarantee, warranty or assurance has been made to me regarding the outcome of the procedure.

I agree that I have read and understood all the information provided. My questions have been answered satisfactorily and I have made an informed decision to receive the Dermalux treatment.

Client Signature *

Tap or click on the signature above to sign

Date *

Practitioner Signature *

Set a reminder:

For (Clinic name)

Date

Post Treatment Advice following a Dermalux® LED Phototherapy Treatment

Following your LED Phototherapy treatment, apply the recommended skin care products which should include an SPF protection (day time only). Your skin care consultant can give you guidance on suitability of your current skin care products during the consultation.

However if LED Phototherapy has been used in conjunction with other aesthetic procedures, specific aftercare advice should be followed.

Make-up can be applied immediately following LED Phototherapy. However, we recommend the use of mineral based or non-comedogenic formulations that allow the skin to breathe.

Drink plenty of water to maintain hydration levels and aid the lymphatic system to eliminate toxins.

In the unlikely event that any adverse reaction occurs following treatment, please contact your skin care professional within 24 hours for advice.

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.

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