HYDRAFACIAL MD CLIENT CONSENT FORM
•. The goal of HydraFacial™ MD is to deep cleanse and hydrate facial skin with improvement in skin tones and texture, acne breakouts and general skin health. Every individual is unique and it is very difficult to guarantee a specific number of treatments needed. Results vary with the individual and in the case of acne and sun damage depend on the amount of acne and compliance with recommended adjunctive measures and skincare. HydraFacial™ MD treatments are recommended every two to three months for optimal results and any time before special events.

•. Common side effects such as slight redness usually subside within a few hours after treatment.

•. Uncommon side effects such as bruising, skin irritation and exacerbation of skin breakout can occur.

•. Rarely, allergic reaction, pigment changes of freckles, moles or skin such as hypopigmentation (lightening) or hyperpigmentation (darkening) can occur and may resolve, but can be permanent. Scarring and textural changes are also rare side effects but can result from this procedure. There may be risks not yet known at this time.

•. Side effects can worsened with sun exposure and daily use of a good quality SPF is very important and highly recommended.

•. I will inform the technician, nurse or physician if my medical condition changes over the course of treatment.

•. The risk of side effects increases with other medical conditions such as immunocompromised conditions (diabetes, HIV, being on immune suppressants such as prednisone) that can be associated with poor skin healing and increased risk of infection. None of these conditions apply to me.

•. Every person is unique and although good results are expected, it is impossible to guarantee.
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By checking this box I agree that I have read and understood this HydraFacial™ MD Consent Form. My questions have been answered satisfactorily by the doctor, nurse or technician. I accept the risks and complications of the procedure.
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