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Dermaplaning Consent Form 

6490 Central Avenue, St Petersburg, FL 33707

DERMAPLANING CONSENT FORM

Dermaplaning (skin blading or leveling) is a safe and highly effective, clinically proven technique for precise, manual exfoliation of the skin. Exfoliation promotes the reduction of fine lines, wrinkles, micro scars, stretch marks, and sun damage. It also regenerates epidermal cell structure resulting in improves skin elasticity and a more youthful, pliable, smooth skin texture. Dermaplaning removes the outer most layers of dead skin cells and the vellous hairs leaving the skin immediately smooth, supple, and vibrant. Dermaplaning is a non-traumatic method of skin rejuvenation and vellous hair removal.

I understand that a sterile surgical blade is used for this procedure. The blade is held at a 45 degree angle and stroked along the face, very similar to shaving

I acknowledge that there is the possibility of nicking or cutting the skin, as a blade is used in this procedure. However, the incidence of cutting into the skin is slim. Our aestheticians have been thoroughly trained in the procedure (a mandatory requirement) and have previous experience performing the procedure

I understand that blading of the skin is performed primarily on the face excluding the nose, eye lids, neck, or chest, and may be performed every 3 – 4 weeks. Blading removes 2-3 weeks’ worth of dead skin cells

I acknowledge that I have been informed that blading the skin on the face DOES NOT cause the hair to grow back thicker or darker. The structure of the vellous hair (thin, translucent blond hair) is not damaged during blading and grows back the same. However, because the hair is cut, it grows back with a blunt edge but the hair has not been physiologically altered

I understand that there is the possibility of the skin to peel after dermaplaning, although this is not common, and if peeling does occur, there is no damage to the skin

I understand that all skin types can benefit from dermaplaning or blading. However, the procedure is not recommended for those suffering from severe acne and/or over production of the sebaceous glands. The oils from the sebaceous glands need to travel up and connect with the vellous hair. If the hair is removed, then the oils tend to stay below where they are prone to mix with bacterial colonies, ultimately stimulating more acne

I understand that there are contraindications to this treatment, including but not limited to diabetes, cancer, active acne, bleeding disorder, and the inability for blood to coagulate following injury. Certain medications including blood thinners, higher dosages of Aspirin, and Accutane are contraindicated for this treatment due to the possibility of delayed clotting from a nick or cut

May 22, 2019

First Client's Name

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Phone*
First Client's Date of Birth*
First Client's Signature*
Second Client's Name

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Second Client's Date of Birth*
Third Client's Name

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Third Client's Date of Birth*
Fourth Client's Name

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Fourth Client's Date of Birth*
Fifth Client's Name

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Fifth Client's Date of Birth*
Sixth Client's Name

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Sixth Client's Date of Birth*
Seventh Client's Name

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Seventh Client's Date of Birth*
Eighth Client's Name

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Eighth Client's Date of Birth*
Ninth Client's Name

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Ninth Client's Date of Birth*
Tenth Client's Name

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Tenth Client's Date of Birth*
Parent or Guardian's Email Address

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Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

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Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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