Facial Services Client Informed Consent Form

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Facial Services Client Informed Consent Form

1. I voluntarily request that The Natural Place Med Spa (and such associates, technical assistants and other skincare professional she or he may deem necessary) to perform Elective Facial Services.

2. Pre-Post Care: Unprotected sun exposure or use of tanning beds, creams in areas to be treated. We might request rescheduling and or no treatment as you are taking risk of injury. Pregnancy, Menstrual dysfunction, use of mechanical epilation less than 4-6 weeks prior to treatment for patients seeking hair removal, Allergies, History of Seizures, Medications, History of Keloid and hypertrophic scar formation. Active Infections/immunosupression. Open lesion, Herpes 1 or 2 within treatment area, Tretinoin (Retin A or Renova), Oral isotrerinoin (Accutane) within the preceding six months. (Dr. Note will be required before Tx is started) No sun-tanning or self-tanners 8 weeks prior to treatment includes spray tans, tanning lotions, tanning beds, sun exposure, etc. Avoid treatments that may irritate the skin for 4 weeks prior to treatment (waxing, depilatories, etc.) Notify clinic with any changes to your health history or medications since your last appointment. History of herpes or cold sores may require an anti-viral prescription prior to treatment if treating in the area that breakouts occur.

Dermaplaning is a skin resurfacing procedure that people use to give the skin a smoother appearance. It uses a blade to remove the top layer of the skin.

Derma Sweep & Gentle Wave is a form of microdermabrasion that is performed without the use of crystals. Traditional microdermabrasion techniques use crystals that hit the stain with high velocity to remove damaged and dying skin cells. Derma Sweep, on the other hand, uses several different attachments that gently scrape the slid with specialized bristles. Gentle Wave- is a low-intensity light therapy that can modulate cellular activity. Gentle Waves increases collagen production while decreasing the production Of enzymes that break down and age the skin. Genie Wave treats wrinkles, uneven pigmentation, and enlarged pores] without heat or inflammation.

Hydro Facial Jet peel can effectively: 1. Clear congestion, removes blackheads and restrains inflammation. 2. Remove scars caused by laser treatment. 3. Smooth some fine lines and wrinkles. 4. Removes facial blemishes, refines large pores. 5. Improves and evens skin tone treatment is suitable for all skin types and is safe and gentle on sensitive skin.

Diamond Glow Silk Peel

An advanced treatment that combines extraction, exfoliation, and infusion of serums to improve your overall skin health. Diamond Glow is non-invasive and a great treatment option for various skin concerns such as aging, hyperpigmentation, acne, dry skin, and more. The device uses encrusted diamond tips (available in 6 levels of abrasion) bound to stainless steel that allows safe treatment on the face including the lip and eye areas. It works by delivering specially formulated Pro-Infusion Serums into your skin. These serums quickly and efficiently target the areas of concern. These specially formulated serums are:

  • Ultra Hydrating
  • Vitamin C
  • Pore Clarifying
  • Brightening (Lumixyl treats Hyperpigmentation)

You can use the Diamond Glow treatment on just about any part of your body and it is suitable for all skin tones and types. Its innovative, dual-port design holds two Pro-Infusion Serums allowing the operator to toggle between serums, providing a fully customizable approach to help address multiple skin concerns in one treatment.

Diamond Glow is a skin-resurfacing treatment that can help create a more youthful look for your skin in addition to improving your skin’s health and function.

EXTRACTIONS: An extraction is the process of clearing a clogged or compacted pore by manual or mechanical means. Extractions are often performed as part of an elective service . Most people need at least a couple of extractions during each tx or an add on service , though you may require more extractions if this is your first unclogging/service. Comedones (blackheads) , Milia ,and or pustules if needed to remove bacteria are the most common reason for extractions.

Eyebrow Shaping /Waxing - Removes unwonted half by gentle hard wax. No retinol or harsh chemicals prior to service.

Last & Brow Tint eyelash tint and/or brow tint applied to my natural eyelashes and/or brows. I consent to the procedure Of an eyelash tint and/ or brow tint by Spa Sweet. Although every precaution will be made to ensure your safety and wellbeing before, during and after your tinting application, please be an/are of the possible risks below, eye irritation, eye pen, stinging, burning, eye itching, discomfort and in rare cases; infection or potential blindness my occur if tint enters the eye. I understand that some irritation, itching or burning may occur to the skin which comes in contact with tinting agent.

3. I understand that my skincare professional can discover other, or different conditions that may require additional or different procedures than those planned. If my skincare professional discovers such other or different conditions, I will be refined to appropriate medical care provider or recommended service that applies.

4. I also realize that the following risks and hazards may occur in connection with the particular procedure; worsening or unsatisfactory appearance, redness, swelling, scarring, or recurrence of the original condition.

If this procedure creates light sensitivity, I understand I must use sunscreen of SPF 45/50 or greater at all times through out the course of treatment.

5. I acknowledge my obligation to follow the written and/or spoken instructions covering my pre and post treatment skincare regimen.

6. I understand that multiple treatments may be required for some services, If so, the cost of these was disclosed prior to the first treatment.

I certify that I have read the above consent and I fully understand it I have been given ample opportunity for discussion and all my questions have been answered to my satisfaction. I hereby consent to the procedure This constitutes the full disclosure and supersedes any previous verbal or written disclosures. I have read, initialed, and acknowledge these requirements, of my procedure to better assist with treatment adversities that can occur if protocol is not taken seriously. I know that this is an elective service and my questions regarding services have boon answered satisfactorily. I understand this procedure and accept all risks and will notify TNP of any changes that could put my treatment at risks, I hereby release The Natural Place, Dr. Copeland, Dr. Buford & Bridget Hahn and staff from all liabilities associated with the indicated procedure.

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