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Skin resurfacing is one of the tools we can use to help you reach your goals and target corrective skin needs. By removing layers of dead skin cell buildup we are able to improve uneven skin texture, fine lines, post acne scarring, hyperpigmentation and clean out acne.

Dermal Vortex: purpose to deep clean pores by extracting impurities.

Microdermabrasion: purpose mechanically break down top layer of dead skin cells.

Chemical Peels: purpose to resurface skin by removing layers of buildup. Peels penetrate the skin therefore have the ability to remove more layers than other types of resurfacing procedures.

Individual results may vary and it is the responsibility of the patient to ensure they are doing the recommended skincare at home to maximize proper skin changes.

SCHEDULING POLICY:

72-Hour cancellation or reschedule notice is required, otherwise you will get charged a  $150.00 cancellation fee no exceptions



Service treatments and packages are non-refundable

LIMITATION TO TREATMENT (Please initial next each statement below):

I acknowledge that no guarantees have been made to me concerning the results of such procedures.  


   

A series of treatments are recommended spaced out from 2-4 weeks apart. 


I understand this treatment is a process and subsequent visits are necessary in order to achieve desired results of which every session has an individual charge. The time in between each session must be followed in order to be effective. 


I understand to start seeing noticeable results it will take at minimum 3 sessions or more 


I understand that the treatment is most successful when I also use the recommended skincare at home and follow the post treatment instructions. 


I understand that if after the treatment course I do not use the proper skincare at home, and do not do maintenance treatments the results of the skin resurfacing will be reversed by the skin’s nature of accumulating new layers of buildup overtime. 


FEES: Sessions can be paid individually or purchased as a package. The Client’s payment obligation is not contingent upon the outcome of services.  


RISKS: I have been informed of the potential risks and side effects of skin resurfacing which mechanically and chemically remove the top layers of the skin.

Possible side effects can include but are not limited to: Allergic reaction, tenderness, scarring, redness, swelling, itching, sensitivity to sun, peeling, flaking, pigmentation. The nature of the proposed procedure, the risks, potential damages, and adverse side effects have been explained to me and I fully understand. I have been informed and I understand that temporary peeling, scabbing, pigmentation, or a minor burn may occur as a result of treatment.


I fully understand this is a process and therefore not an exact science and that all clients have different experiences and outcomes due to their unique skin conditions. I accept full responsibility for the decision to have this esthetic work performed on me and I accept the possible consequences of procedure. 


Contraindications:
• Patients who have an aspirin, hydroquinone or phenol allergy • Patients who have used oral isotretinoin (Accutane) within the past 6 months • Patients who have active cold sores, warts, open wounds or history of herpes simple • Patients who are undergoing chemotherapy and or radiation therapy within 6 months • Patients with a history of an autoimmune (i.e. Lupus) or liver disease/disorder as well as any condition that may weaken their immune system

I understand that there may be some degree of discomfort such as burning, stinging, redness, heat or tightness during and a week after the procedure. 


I understand that there is no guarantee of the final results of the peel. Occasionally hyperpigmentation may develop which may persist for a week or months after the peel. 


I understand although complications are very rare, sometimes they may occur. In the event of any complications, I will immediately contact our office so we can assist you 


I understand if I have acne condition in the skin, the peel will bring out oils and bacteria from below the surface and you will see the acne come out to the surface. 


I understand direct sun exposure including tanning beds are strictly prohibited before and after receiving Peels. 


I understand no activities involving excessive sweating can be done for 72 hours (exercise, sauna, hot tub steam room and that overheating may cause me to develop blisters or cause hyperpigmentation. 


I understand that I must protect my skin with SPF 50+ and avoid sun exposure during the 7 day exfoliation process. 


I understand that this is an elective cosmetic procedure. 


PATIENT CARE:

Your safety and client satisfaction is our priority. With Aesthetic Treatments there may be a lot of questions you will have; please know we are here to assist you before and after your treatment with us. Skin Resurfacing is a process and it will not happen immediately or in one session, this is a process and requires patience and multiple sessions. If for any reason you have concerns or are unsatisfied, we ask you to contact our office right away to give us the opportunity to assist you. We are here to resolve any issue that may arise. By signing you are accepting these terms and agree to contact our office directly via email, text or phone to address any concern, question or to give us your feedback.

I, the undersigned, understand and accept the conditions as laid out above.


Date: April 26, 2024

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Referred By:
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.


By signing below the parent or court-appointed legal guardian agrees that they are also 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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