MICRODERMABRASION CONSENT FORM
1. Prior to receiving this treatment, I have been candid in revealing any condition that may
have a bearing on this procedure, such as pregnancy, recent facial peels or surgery,
allergies, tendencies to cold sores and fever blisters, use of Retin-A, Accutane or
Hormones.

2. I understand there may be some degree of minor discomfort, i.e., scratchiness, itchiness.

3. I understand there are no guarantees to this procedure.

4. I understand that to achieve maximum results, I will need several ongoing treatments
and use a daily product over a period of time.

5. I understand that the possibility of irritation and redness exists and that I should notify
my skin care professional when irritation persists.

6. I will follow the home care program specifically designed for me without changing or
adding any products without consulting with my skin care professional.

7. I have read the enclosed consultation and understand the contents.
I agree to all of the above to have this treatment performed on me and will follow all prescribed directions regarding post peel care.
Name
Email
Phone
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy