Dermaplaning Consent Form

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Email *

NAME *

PHONE NUMBER *

DATE OF BIRTH *

YYYY

STREET ADDRESS, CITY, STATE, ZIP CODE *

I understand that Dermaplaning involves the use of a surgical blade to remove fine vellus hair from the face, along with light exfoliation. *

I Understand

The nature and purpose has been explained to me and any questions I have regarding the treatment have been answered to my satisfaction. *

I Agree

I understand that the treatment may involve the risk of complication or injury and I freely assume those risks. Possible side effects of the treatment area can include mild redness of the skin, irritation, and dryness additionally, nicks to the skin can occur due to the sharp surgical blade. The hair that grows back will not be darker or thicker, however I do understand that any hormonal imbalance that may be present within my anatomical system can alter the normal hair growth pattern. *

I Understand

I will call to inform my clinician of any complications or concerns as soon as they occur. *

I Agree

I certify that I have read this entire consent and that I understand and agree to the information provided in this form. I certify that I am 18 years of age, or I have a parental consent co-signed below. *

I Certify

FULL NAME, USED AS SIGNATURE *

TODAY'S DATE *

YYYY

TIME *

Time

IF UNDER THE AGE OF 18, PARENT/GUARDIAN NAME, USED AS SIGNATURE *

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