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Client Hydrodermabrasion Consultation & Consent Form

The hydrodermabrasion facial is like a “pressure wash” that uses jet technology to deep clean by infusing saline and oxygen into the skin, leaving it hydrated, exfoliated and feeling refreshed. There is no pain, no downtime and it feels cool and soothing to your skin.

Lifestyle Questions:

Client Treatment Report

Home Care Regime

AM
PM

Medical Informed Consent


I consent and authorise________________________________ to perform hydrodermabrasion treatment on me. I understand the following points and have had the opportunity to ask questions during my consultation.

In relation to my initial and all subsequent treatments I advise that: (Please tick)
  • Treatment is successful on most clients but my individual results cannot be guaranteed.
  • Most clients require 6 – 10 treatments to achieve results, some may require more. Individual results depend on many factors; thus, it is extremely difficult to advise on exact number of treatments required.
  • Exposure to UV Rays will compromise my treatment, therefore I will use SPF 30+ sunscreen.
  • ot following the program regarding timing of treatments and after care advice will reduce/affect efficacy of my treatment
Risks associated with treatment: Even though the risk of Hydrodermabrasion complication is extremely low, the following can occur: (Please tick)
In relation to my initial and all subsequent treatments I advise that: (Please tick)
I have read all of the above and had all my questions satisfactorily answered. Note: Do not sign this form until you have read and understood all of the above.

Pre & Post Care Information Sheet
(Client Copy)

Pre-Hydrodermabrasion Treatment Recommendations

  • Do not wax, pluck, use depilatory creams or undertake electrolysis for 2 weeks prior to treatment, and in between treatments.
  • Do not use prescription strength exfoliant creams (Retin-A and Alpha Hydroxy) for 2 weeks prior to treatment.
  • Do not shave for up to 1 weeks prior to first treatment. Please shave the night before all subsequent treatments.
  • Avoid tanning, including self-tanning lotions, tanning bed/booths or sun exposure, for 4 weeks prior to and in between treatments. A sunscreen with SPF 30 or greater should be used on any area of sun-exposed skin, which you plan to treat.

Post-Hydrodermabrasion Treatment Recommendations

  • A mild sunburn-like sensation is anticipated.
  • Avoid sun exposure to treated areas. Apply a sun block with SPF 30 or greater daily to sun-exposed treated areas between treatments and for 4 – 6 weeks after last treatment.
  • Bathe or shower as usual. Treated areas may be temperature sensitive. Avoid use of strongly scented lotions or soaps, prescription strength exfoliant creams, loofah sponges, and aggressive scrubbing to treated areas during healing phase
  • Best results are obtained on clients who have follow up treatments after their series. Your clinician will advise you when you should schedule your next appointment. It is important to adhere to this regime.

    IMPORTANT: With all hydrodermabrasion treatments described above, the following recommendations apply:

  • Until redness has completely resolved, avoid all the following:
  • Applying cosmetics on treated areas
  • Swimming, especially in pools with chemical/chlorine
  • Hot tubs and jacuzzis
  • Activities that cause excessive perspiration
  • Avoid sun exposure to treated areas
  • Do not pick, scratch or remove scabs as this will cause unwanted side effects
  • Apply a sunscreen with SPF 30+ daily to sun exposed skin, AND REAPPLY AS DIRECTED BY PRODUCT INSTRUCTIONS
  • Increased photosensitivity to UV can occur when taking certain medications. During your treatment programme, if you have commenced or changed dosage with the following medications, you must advise your clinician:
  • Antibiotics – doxycycline (acne), minocycline, tetracyclines, sulphonamides
  • Antihistamines – diphenhydramine, cyproheptadine
  • Antidepressants
  • Herbal preparations – St John’s wort, gingko biloba, citrus oils, herbal HRT therapies

Taking these medications does not exclude you from hydrodermabrasion treatment; however extra precautions are applicable in these cases.

For any questions, concerns or booking please contact our salon on ………………………………………….…

In the event of an emergency, contact our senior clinician directly on …………………………………………… or your local doctor

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