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Microdermabrasion Informed Consent Form Client/Patient consent to treatment My signature acknowledges that I have read and agreed to receive the following treatments for series of treatments listed below. I consent to and authorize Be Medspa or members of its staff to perform Microdermabrasion exfoliation procedure and related services on me. Areas to be treated Number of treatments estimated a* b. c* d. e. f* g. h. i. j. The nature and purpose of the treatment has been explained to me and any questions I have regarding this procedure has been explained to my satisfaction* initial. I understand that with any treatment certain risks are involved and that any complications or side effects from known or unknown causes could occur. I freely assume these risks. initial I have discontinued the sue of Retinol and any other topical medications for at least one 1 week prior to this procedure. initials Possible side effects include but are not limited to Mild redness extreme redness bruising local swelling stinging tenderness dry skin flaking lightening or darkening of the skin infections pimples bumpy appearance and cold sores. Most side effects are temporary and generally fade within seventy-two 72 hours. initials If prone to cold sores see your physician about a prescription for acyclovair zovirax or take supplements of L-Lysine along with beta-carotene and folic acid daily. initial It is recommended to discontinue all AHA s Glycolics or any exfoliating products for up to seventy-two 72 hours post procedure. Use hydrating soothing antioxidants healing and ice for swelling and inflammation reduction* Also no sun exposure seventy-two 72 hours an use of an SPF 15 or greater at all times during treatment duration is recommended* initial Removal of contact lenses in recommended* initials. I agree to adhere to all safety precautions and home skin care program as recommended by my practitioner. initials I am over 18 years of age or I have parental consent co-signed below. initials I will call to inform my practitioner of any complications or concerns I may have as soon as they occur. initials Co-Signature Date Medical Director Signature Date Be Medspa 8322 Bellona Avenue Suite 300 Towson MD 21204 410. I consent to and authorize Be Medspa or members of its staff to perform Microdermabrasion exfoliation procedure and related services on me. Areas to be treated Number of treatments estimated a* b. c* d. e. f* g. h. i. j. The nature and purpose of the treatment has been explained to me and any questions I have regarding this procedure has been explained to my satisfaction* initial. Areas to be treated Number of treatments estimated a* b. c* d. e. f* g. h. i. j. The nature and purpose of the treatment has been explained to me and any questions I have regarding this procedure has been explained to my satisfaction* initial. I understand that with any treatment certain risks are involved and that any complications or side effects from known or unknown causes could occur.

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Keywords relevant to Microdermabrasion Consent Form

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  • Glycolics
  • L-Lysine
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  • Bellona
  • hydrating
  • exfoliating
  • antioxidants
  • exfoliation
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  • carotene
  • redness
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