L Aesthetics

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Microderm / Hydra Facial Consent Form

Name(Required)
DD slash MM slash YYYY
e.g. latex, peanuts, shellfish, aspirin
Are you currently on or have taken the following medications in the last six months?
Are currently experiencing any of the following?
Have you had any of the following in the last 6 months?

Consent

The treatment protocol and due process has been thoroughly explained to me and I understand that I may or may not experience:

  • mild discomfort during the treatment
  • possible bruising or petechia post treatment
  • Redness that may last up to three days

I understand I am to use SPF sunscreen every day during the recovery period and beyond, commencing the day after treatment. I also understand I must not expose my skin directly to the sun on the day of the treatment prior to and post.

Consent(Required)
Name(Required)
DD slash MM slash YYYY
Clear Signature