FACIAL CONSENT FORM INFORMATION

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    PERSONAL INFORMATION

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    I confirm that the practitioner who carries out aesthetic treatments using ND YAG for vascular/rejuvenation/pigmentation or Microdermabrasion/Micropeel/Glycolic Peel/Deep Cleanse/hydradermabrasion treatments has given me sufficient information to enable me to understand the treatment in accordance with its approved indication


    I have received information regarding its contra-indications and potential undesirable effects on treated areas including redness, bruising, warmth/tingling sensation , possible acne breakouts, photo-sensitivity reactions to the laser, burns, blistering and changes to skin colour (lighter or darker)


    I have been given the opportunity to ask questions regarding the treatment and these have been answered to my satisfaction.


    I have answered the personal and medical history questionnaire fully and to the best of my ability. I also understand that it is important to tell my practitioner of any changes in my personal and medical status.


    I understand that results with this type of treatment may vary from each individual patient and they are not guaranteed.


    I have answered the personal and medical history questionnaire fully and to the best of my ability. I also understand that it is important to tell my practitioner of any changes in my personal and medical status.


    I understand that results with this type of treatment may vary from each individual patient and they are not guaranteed.


    My practitioner has taken pre-treatment photograph to monitor my treatment progress.


    I understand that my photos may be used for promotional purpose (Uncheck if you do not allow this)


    I have been correctly informed and I consent to the above treatment.


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