Yes or No, please explain
Yes or No, If yes please list:
Yes or No, If yes, date and cause of last cold sore?
Yes or No, If yes when was that
I give my consent for Dermaplaning to be performed by Paige Ashley Aesthetics.
Dermaplaning is a physical exfoliation that removes dead skin cells and vellus hair from the surface of the face.
This form of exfoliation smooths the skin and allows for the active ingredients in skincare products and
treatments to penetrate deeper which increases their efficacy & anti-aging benefits.
Alternatives to dermaplaning include microdermabrasion and scrubs for exfoliation, and waxing, threading,
or cream depilatory for hair removal. There is no single treatment to replace dermaplaning.
Happy Peel is a superficial chemical peel for all skin types. The combination of dermaplaning and Happy Peel
is an advanced exfoliation treatment.
I understand there are contraindications to this treatment, including but not limited to diabetes, pregnancy/
lactation, an allergy to the product ingredients used, cancer, active acne, bleeding disorders, and the inability
for blood to coagulate following injury. Certain medications including blood thinners, higher dosages of
Aspirin, and Accutane are contraindicated for this treatment due to increased sensitivity and/or the possibility
of delayed clotting from a nick or cut.
I certify that I am not taking any of the above medications or experiencing any of the above conditions.
Alternative treatments such as waxing to remove vellus hair and microdermabrasion for exfoliation, along with
their associated risks, have been explained to me as other options.
I understand this treatment involves the use of a specialized dermaplaning blade to remove dead skin cells and
vellus hair. As with the use of any sharp instrument, there is the possibility of injury. While every precaution is
taken, I understand the risks and consent to receive treatment today.
