Facial Consent Forms

Intake Facial
Which treatment are you interested in having?

Do you have any of the following?

Open Lesion or cold sore
Active acne or infection
An active infection in the treatment area
Active sunburn
Skin condition such as eczema, dermatitis, or rashes
An autoimmune disease such as lupus
A viral concern such as HIV herpatitis
Anticoagulants Therapy
Melanoma or lesions suspected of malignancy
Pregnancy or lactation
Neurological disorders such as epilepsy (LED Lights)
Infection in the urinary systems i.e. kidneys, bladder and urethra (Lymphatic Drainage)
Chron's disease (Lymphatic Drainage)
Hypervehyroidism (Lymphatic Drainage)
Deep venous thrombosis (Lymphatic Drainage)
Lymphedema (Lymphatic Drainage)

HydraFacial What to Expect

Hydrafacial is the only hydradermabrasion treatment that combines cleansing, exfoliation, extraction, hydration and antioxidant protection simultaneously, resulting in clearer, more beautiful skin with little-tono downtime. The treatment is soothing, moisturizing, non-invasive and generally non-irritating. As with most procedures, visible results from Hydrafacial will vary from person to person.

What to expect:

Your skin may experience temporary irritation, tightness, or redness. These are all normal reactions
that typically resolve within 72 hours depending on skin sensitivity.

  • You may experience tingling and stinging in the treatment area. These sensations generally subside
    within a few hours.
  • Client experiences may vary. Some clients may experience a delayed onset of these symptoms.
  • You will likely see results immediately after treatment and your skin may feel smooth and hydrated for one to four weeks with appropriate home care to maintain treatment results.
  • The skin is more susceptible to sunburn/sun damage. Avoid excessive sun exposure and use a minimum of SPF 40 sunscreen
HydraFacial What to expect

HydraFacial Terms and Conditions

I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols
that are not part of the recommended take-home regimen in the treated areas for minimum 2 weeks
pre-and post-treatment.

Photos may be taken before, during and after the Hydrafacial treatment. Photos will only be used with
my written approval for education, promotion or advertising purposes.

The information provided has been explained to me and all my questions have been answered to
my satisfaction. I have read the above information, and I give my consent to have the Hydrafacial
treatment by the staff at Elite Spa (Elite Rejuvenation Center INC)                       .
By signing below, I acknowledge that I have read the above information and give my consent to be
treated with the Hydrafacial System. This consent form Is valid for all future Hydrafacial treatments.
I will alert the staff If there are any future changes to my medical history.

HydraFacial Terms and Conditions

I have read the information above, I understand and accept this informed consent.

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