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Please complete this consent form before your Hydrafacial appointment. Once you sign, a copy is emailed to you and to Gemma automatically.

Your details

Hydrafacial — treatment information & disclaimer

The Hydrafacial is a non-invasive water-assisted treatment that combines cleansing, exfoliation, extraction, hydration and antioxidant protection in one session, using a gentle mix of water and mild exfoliating acids. It can improve the appearance of dull skin, uneven tone and texture, congestion and dehydration. Results vary between individuals and more than one session may be needed; it is not a treatment for significant scarring or deep lines.

Common side effects are mild and short-lived — the skin may feel slightly tender and look a little red immediately afterwards, usually settling within a few hours. Occasionally minor breakouts or mild sensitivity can occur. Your skin may be more sensitive to sunlight afterwards, so please use SPF.

Rare risks include skin infection, reactivation of cold sores, or an allergic reaction to a product used. Please disclose any allergies, skin conditions, recent treatments or medication before we begin so the treatment can be tailored safely to you.

A non-refundable deposit is required to secure your appointment. The balance is payable at your appointment. Deposits and booking fees are non-refundable unless agreed with the practitioner.

Medical screening

Please answer honestly — this keeps your treatment safe. Add detail in the notes where relevant.

1. Are you pregnant, breastfeeding, or trying to get pregnant?
2. Do you have any medical conditions? If yes, please give details.
3. Are you taking any medication (including blood thinners such as Warfarin/Aspirin)? If yes, please list.
4. Do you have any allergies, or have you ever had anaphylaxis? If yes, please give details.
5. Do you have any skin or neuromuscular disorders?
6. Do you have diabetes, an autoimmune disease, or a bleeding/clotting disorder?
7. Do you have a history of keloid or hypertrophic (raised) scarring?
8. Do you have any active infection, cold sores, or inflammation at the treatment area?
9. Have you had this or a similar treatment before? If so, did you have any problems?
10. What are your aims and motivations for the treatment / desired outcome? Please give details.
11. Is there any other medical or social history we should know? Please give full details.
12. Do you understand the information provided and feel it is sufficient for you to consent?
13. Has your consent been given freely?

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