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Questionnaire on fruit acid treatment
Form english (please men do not shaveat the appointment)
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Surname, first name
*
Your answer
Mobile number (please with country code)
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Your answer
For customers with the following skin diseases or the following medical indications, treatment with fruit acid should be avoided, please select the appropriate:
*
Pregnancy/breastfeeding
Allergies to acids (e.g. citrus fruits, pineapple, etc.)
If the customer is undergoing dermatological treatment
Acute eczema, psoriasis (psoriasis), neurodermatitis
Surgical interventions in the facial area within the last 6 months
Regular intake of blood thinners, e.g. Marcumar and antibiotics
Propensity to keloid formation (scirs that protrush beyond the edge of the wound)
Current herpes infection (wound healing disorder)
Existing cancer and/or currently ongoing chemotherapy
Taking Roaccutan (Isotretinoin) within the last 6 months
Intake and/or external and oral use of vitamin A (retinol) acid in the last 6 months
Injections in the facial area in the last 2 weeks
Skin peeling treatments in the last 6 months
Inflammatory skin symptoms
Bacterial or virus-related skin diseases
Fresh scars or skin injuries on the face
Sunburn or solarium visit within the last 7 days
None of the options apply to me
For customers with the following skin symptoms or after certain situations, please avoid the relevant skin areas:
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Immediately after shaving
Hair treatment (hot wax, depilatory agent)
None of the options apply to me
Indication for shortened exposure time:
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Very light skin types (Asian skin)
Very dark skin
Taking high-dose enzymes, e.g. Wobenenzym, pineapple, papaya, as enzymes accelerate processes in the metabolism!
None of these options apply to me
I am aware that the following side effects can occur:
Especially with the first application: skin redness, feeling of heat, burning/itching
A slight scaling may occur in the first few days
It can lead to crusting or superficial bleeding, do not scrape off!
Possible intolerances, especially against fruit acids
Short-term "blooming" of an acne (is very rare)
If you are prone to herpes simplex (lip herpes), such a reaction can occur after the fruit acid treatment!
On the day of treatment, no shaving should be done and make-up should be avoided
No direct sunlight and solarium in the next 8-10 days! The skin can react with hyperpigmentation! Please use a high sun protection factor!
Please do not use a peeling or the like about one week after the fruit acid treatment!
I have taken note of possible side effects:
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Yes
No (marking this means no appointment possible)
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Due to the GDPR provision, I have to ask for permission for the storage of your data for contact and information (inspection of storage regulations:
https://www.top-in-form.net/j/privacy
) :
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Yes
No (unfortunately no appointment possible - the request will be deleted)
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