All information is collected by Ivonne Sanchez Beauty pursuant to O. Reg. 136/18: PERSONAL SERVICE SETTINGS and The Personal Information Protection and Electronic Documents Act (“PIPEDA “).
The words “I”, “you” and “your" are used interchangeably throughout this agreement and in all cases refer to you the client who is receiving the treatment or procedure.
“Practitioner”, “technician”, “instructor” and “we” means 10981508 CANADA INC. (“Ivonne Sanchez Beauty”), its staff or contractors.
Microneedling Informed Consent
I have received a consultation with a member of the Ivonne Sanchez Beauty team and I consent to the treatment of Microneedling or stem-microneedling to be carried out upon myself.
The Microneedling treatment allows for controlled induction of growth factor serums, or hyaluronic acid, into the skin which is understood to be a factor in the self-repair process. Sometimes microneedling is understood to be a form of micro-injury that may stimulate new collagen production, while not posing the risk of permanent scaring. The result is smoother, firmer and younger looking skin. The skin needling treatments are performed in a safe and precise manner with a single use sterile needle cartridge and are usually completed in 60- 90 minutes.
No guarantee can be given to me as to the condition of my skin or degree of improvement expected following my procedure(s). It is recommended that up to 3 to 6 treatments may be needed to obtain desired results or to determine the efficacy of microneedling treatment.
I understand that any skin conditions or concerns must first be discussed with my family physician who is the primary point of contact and owner of my health care plan. Microneedling at Ivonne Sanchez Beauty is not a substitute or alternative to institutional public health care.
I acknowledge that if I am being treated by a physican for any skin diseases or conditions that my doctor must first approve of this microneedling treatment before proceeding.
I understand that multiple treatments may be needed and the use of home care products is recommended to achieve optimal results.
I understand that I must follow the provided aftercare instructions given to me by my technician and that I must always wash my hands before touching my skin.
If outdoors, I will use protective clothing e.g. hat or sun-brella, and apply broad spectrum sunscreen with SPF-30 or higher, 30 minutes prior to sun exposure and wear daily until all areas treated have healed and after the treated areas have healed.
In rare cases, allergies or sensitivities have been reported in products used during treatments (topical numbing).
I understand that the questions in the attached Health Questionnaire may disqualify me as a candidate for any microneedling procedure.
I understand that if I am receiving these services at a discounted rate e.g. as a model in the beauty training program, that the service times and work product will not be the same as a regular service and that I am willing to work with the business or the trainee to support their learning.
I understand that there are no refunds.
I understand that the following possible side effects and/or risk could occur:
Microneedling induces physical damage to the skin, which may cause or promote infections if microorganisms are introduced under the skin during the process. The potential sources of microorganisms include:
• Contaminated and/or improperly reprocessed equipment or ink (Ivonne Sanchez Beauty adheres to sanitation protocols and does not reprocess single-use products)
• Client’s own bacteria on the skin.
• Unclean hands touching the treatment area.
Potential infections can be caused by bacteria (e.g., Mycobacterium spp. or Staphylococcus aureus), fungi (e.g., Candida endophthalmitis), or even viruses (e.g., human immunodeficiency virus [HIV], hepatitis B virus, hepatitis C virus)”
Side Effects Typically Include:
- Skin will be pink or red and may feel warm, like mild sunburn, tight and itchy, which usually subside in 12 to 24 hrs
- Minor flaking or dryness of the skin, with scab formation in rare cases.
- Crusting, discomfort, bruising and swelling may occur.
- Pinpoint bleeding.
- It is possible to have a cold sore flare if you have a history of outbreaks.
- Infection is rare but if you see any signs of tender redness or puss notify our office immediately.
- Hyperpigmentation (darkening of the skin) rarely occurs and usually resolves itself after a month.
- Permanent scarring (less than 1%) is extremely rare.
In most cases, redness will begin to subside within 24-72 hours.
AVOID EXPOSURE TO DIRECT SUNLIGHT UNTIL THE AREAS HAVE COMPLETELY HEALED. (72 hours)
I have read and understand the contents of this consent.
Today's Date: July 3, 2020