Dermaplaning

Name

First Name

Last Name

Informed Consent:

I understand that if I have any of the following conditions, I will inform my Rich Earth Organic Skin Care practitioner that I should not receive a dermaplaning treatment and will opt for a service that has no known contraindications for my skin:
• dermatitis
• eczema
• psoriasis
• rosacea
• active acne (a few small pustules are fine)
• skin cancer
• thin, sensitive, delicate skin
• thin, inflamed, reactive skin
• an abundance of solar keratosis
• an abundance of moles
• an abundance of skin tags
• if I am taking blood thinners
• if I have a blood coagulations disorder
• if I am using Retin-A, I understand I must discontinue use several weeks prior to dermaplaning
• if I am using Accutane, I understand I must discontinue use at least 1 month prior to dermaplaning
• If I am using isotretinoin, I understand I must discontinue use at least 1 month prior to dermaplaning
• I understand I must wait at least 1 month after a medical grade laser treatment before dermaplaning
• I understand I must wait at least 2 weeks after any strong, professional exfoliation (such as microdermabrasion, peel, etc.,) before dermaplaning
• I understand I must wait at least 5-7days after Botox, neuromodulators or facial filler injections before dermaplaning

Signature - by typing your name here, you are acknowledging that you have read and understand the information presented to you.

Release of Liability:

By signing this agreement, I am confirming I understand there may be inherent risks associated with receiving facials/treatments and using skin care products, including those provided by Rich Earth Organic Skin Care Studio. I acknowledge and agree I am responsible for my own health; that Rich Earth Organic Skin Care Studio and Rich Earth Organic Skin Care Studio practitioners cannot be expected to diagnose and/or treat individual health problems. By voluntarily choosing to receive facials/treatments and/or use skin care products, I warrant that to the best of my knowledge, I have no condition that is contraindicated for receiving such facials/treatments and using such skin care products. I understand it can be impossible to guarantee or predict a specific aesthetic outcome, so no such guarantee has been made to me. I also understand it can be impossible to predict who may have an unexpected, adverse reaction to a facial/treatment or skin care product, and as such, I acknowledge that I am choosing to receive facials/treatments and to use skin care products of my own free will, with the complete understanding that I cannot hold Rich Earth Organic Skin Care Studio responsible for any inherent risk or unexpected adverse reaction that could occur. In light of the foregoing, I hereby release Rich Earth Organic Skin Care Studio and its practitioners and waive any and all claims, liabilities, or damages for personal injuries that I may experience directly or indirectly from receiving facials/treatments or using skin care products provided by Rich Earth Organic Skin Care Studio.

Signature - by typing your name here, you are acknowledging that you have read and understand the information presented to you.

Date

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