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Informed Consent For Dermaplaning

I

give my consent for Dermaplaning to be preformed by Cheryll Cerasoli on October 29, 2020.

Dermaplaning is a physical exfoliation that removes surface dead skin cells and vellous hair from the face. This form of exfoliation smooths the skin and allows for the active ingredients in skincare products and treatments to penetrate deeper into the skin furthering their anti-aging benefits. 

Alternatives to dermaplaning include microdermabrasion and scrubs for exfoliation, and waxing, threading or cream depilatory for hair removal. There is no single treatment to replace dermaplaning. 

I understand there are contradictions to this treatment, including but not limited to diabetes, cancer, active acne, bleeding disorders and the inability for blood to coagulate following injury. Certain medications including blood thinners, high doses of Aspirin, and Accutane are contradicted for this treatment due to increased sensitivity and/or the possibility of delayed clotting from from a nick or cut. 

I certify that I am not taking any of the above medications or experiencing any of the above conditions. Alternative treatments such as waxing to remove vellous hair and microdermabrasion for exfoliation, along with their associated risks, have been explained to me as other options.

I understand this treatment involves the use of a surgical blade to remove dead skin cells and vellous hair. As with the use of any sharp instrument there is the possibility of nicks or cuts. While every precaution is taken, I understand the risks and consent to recieve treatment today.

October 29, 2020

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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.
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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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