Open
Doctor's Search
Search Team Members by name and also by section
Search
Call us now!
248-426-7200
Modern Medicine; Old Fashioned Care
Toggle menu
Skip to content
PrimeCare of Michigan
>
Dermaplaning Consent
Dermaplaning Consent
Dermaplaning Consent
Name
First
Last
Date
MM slash DD slash YYYY
I acknowledge
(Required)
I understand that Dermaplaning is the process of removing superficial layers of dead skin cells and vellus hair on the skin’s surface by the use of a sterile blade.
I acknowledge
(Required)
I understand that there may be unforeseen risks with Dermaplaning such as nicking, scraping or abrading the skin with the blade.
I acknowledge
(Required)
I understand that possible side effects of the treatment area can include mild redness of the skin, irritation and dryness.
I acknowledge
(Required)
I understand that if a chemical peel is part of this treatment, that the sensation and penetration of the peel will be enhanced. This may cause minor skin irritation, mild discomfort, and tenderness, lightening or darkening of the skin, peeling and activation of cold sores.
I acknowledge
(Required)
I understand the results of this treatment may vary due to conditions such as age, condition of skin, sun damage, climate, etc.
I acknowledge
(Required)
I understand that in order to see significant results these treatments need to be done in a series and in combination with using active ingredient skin care products
I acknowledge
(Required)
I understand that direct sun exposure, including tanning beds, is not recommended while undergoing treatment and the use of a daily sun block protection is mandatory.
I acknowledge
(Required)
I understand that any facial injections should be avoided 10 days before this treatment.
I acknowledge
(Required)
I am not using Retin A®, or other retinol derivatives, products containing Alpha Hydroxy Acids (AHA) or Beta Hydroxy Acids (BHA) and have been off these products at least 3 days prior to treatment.
I acknowledge
(Required)
I will call my practitioner if I have any questions or concerns about my treatment.
I acknowledge
(Required)
I have been advised not to exercise after my treatment. I agree to have this treatment performed on me. I further agree to follow all post-care instructions. Prior to receiving any treatment, I have been candid in revealing any condition that may have a bearing on this procedure. I am over 18 years of age.
Signature
Search
+
