CONSULTATION FORM - Facials / Chemical Peels / Microneedling

I have provided accurate medical information and consultation details to my advanced aesthetic practitioner. *

I do not have any active Herpes simplex (cold sores). Prophylactic antiviral medication or topical antiviral cream may be used up to 2 days before and up to 3 days after the procedure.*

I agree not to receive any of the following on the procedures area 2 weeks prior to the procedure – Botox, injectable dermal fillers or chemical peel/microneedling procedures.*

I agree not to receive any of the following on the procedure area 2 weeks prior to the procedure – bleaching, electrolysis, depilation, facial treatments using AHA/BHA/Vitamin A, hair colouring, IPL/Laser for skin rejuvenation, IPL/Laser for hair removal, light therapy, microdermabrasion*

I agree to avoid the use of any prescribed topical medications i.e. Retin A, Salicylic Acid a minimum of 2 weeks prior to the procedure.*

I confirm that I have not used Isotretinoin in the past 6 months.*

I agree to avoid the use of active skin care 3-5 days prior to the procedure.*

I agree to avoid direct sun exposure.I agree to apply a sunscreen daily (minimum SPF30).I agree to avoid fake tanning preparations a minimum of 10 days prior to the procedure.*

I agree to avoid heat treatment immediately prior and after the procedure.*

I understand that the following contra-actions may occur:   

·         Acne breakouts           

·         Excessive flaking         

·         Blanching      

·         Frosting         

·         Hypopigmentation

·         Hyperpigmentation

·         Discomfort   

·         Itching/irritation          

·         Scarring

·         Excessive erythema (redness)  

·         Infection       

 *

I understand that procedure results are varied and not guaranteed.*

I have discussed my expectations and goals with my advanced aesthetic practitioner.*

I acknowledge the possibility of an adverse reaction to procedure and take sole responsibility for any medical care that may become necessary. I agree to immediately contact the advanced  aesthetic practitioner performing the procedure of any adverse effects.*

My advanced aesthetic practitioner has provided the procedure information and answered all of the questions I have concerning this procedure.*

I fully understand all of the above information.*

I understand that consultation cost is £25 (This can be used as credit for first full price procedure if consultation is attended). Any last minute cancellations will incur a charge of £25.