What procedure are you having done using "Clear" by Skin SheekTM? *
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Please carefully read through and check off the following that you are agreeing too. * |
I am not presently pregnant or lactating |
I have not had any Botox in the past 2 weeks, or used retinoids for 3 or more days |
I do not have a severe allergy to nickel |
I am not on any blood thinners or high doses of aspirin |
I have been informed of the possible risks and complications which may include, but are not limited to, infection, hyper-pigmentation, redness, edema, bruising. |
I understand that this procedure will make my skin photosensitive and I must apply SPF 30 or higher 10 minutes prior to sun exposure |
I do not currently or have a history or prior history of: Pace maker, keloid scarring, viral Infections, auto immune disease, vascular disease, cold sores (may cause slower healing time), anxiety issues, glycation, have taken Accutane in past 6 months |
I have been given a copy of pre-care, post-care, and home instructions |
I understand home care and maintenance are required to achieve optimal results |
I agree to follow the post-care, and home instructions |
I understand numbing is optional |
Post treatment healing time is usually 7-10 days, it is highly recommended to purchase LuxMDTM post treatment medical balm, it will speed healing times |
I understand the potential risks and complications and choose to proceed after careful consideration of the possibility of both known and unknown risks, complications, limitations and alternatives |
Please select if you consent to the following: |
I consent to the taking of photographs to monitor treatment results |
I consent to before and after photographs of treatment being posted publicly |
Please list any Medical Diagnosis:
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Please list any Medications:
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Please list any current medical treatments:
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