Skin Pen Consent Form

Client Statement:

The information I have given within this document is, to the best of my knowledge correct. I have not withheld any known medical history or condition.

• I have read and understand the Consultation form and that I am over 18 years of age (or my parent or legal guardian is giving consent on my behalf) that:
• I understand that the conditions listed in the consultation form and consent form can make me unsuitable for the required treatment. It is my responsibility to inform my practitioner if my circumstances change, on each and every visit for treatment.
• I have been informed that the person providing my treatment is a fully qualified beauty therapist or medical aesthetic practitioner and is suitably qualified to perform this procedure.
• I have been fully informed about the procedure I am to receive including the possible side effects and the aftercare procedures I must follow
• I freely assume responsibility for any risks of complications or injury from known or unknown causes associated with, relating to, or otherwise arising out of this procedure.
• I consent to the taking of both before and after treatment photographs

GP Disclaimer:
I understand that the General Medical Council advise that General Practitioners are kept fully informed about all treatments undertaken by their patients. Either I have informed my General Practitioner, or in signing this form I am exercising my right not to inform my General Practitioner about the treatment I am about to undertake.

I have read and understood this consent form, all the above matters have been explained to me and my questions have been addressed and answered to my satisfaction.

Treatment details

Anaesthetic used & verification that reactions were normal. Any adverse reactions to the anaesthetic must be detailed.

Post Procedure Advice

Following your treatment with the skin pen, your skin will feel warm and will have mild redness and slight discomfort, feeling similar to mild or moderate sunburn. It is Important to treat the skin gently and until the skin has completely recovered, you should follow the following advice.

Stop using AHA’s (glycolic Acid) Retin A (retinol) or any “active ingredients” for 3-4 days post treatment or until the skin has fully covered

Avoid touching or picking at the skin

Avoid any heat treatments, vigorous exercise, sauna steam rooms for 24hours or until the skin has fully recovered following the treatment

Avoid sun exposure until the skin has fully recovered, or use zinc-based sunblock

If the skin feels hot, apply a wet compress such as a wet flannel

Do not wear make up for 24 hours post treatment

Avoid 7 days post treatment any regenerative or invasive treatments such as : Waxing, Peels, Laser, IPL, Resurfacing, RF, Filler, Botox etc

If you have any concerns please contact the salon/practitioner

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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