The instructions and guidelines provided in this informed consent should be followed by all individuals receiving a Professional Resurfacing Treatment Please read and initial after each paragraph acknowledging that you have read and understood all of the information presented.
PROFESSIONAL RESURFACING TREATMENT
INDIVIDUALS WHO SHOULD NOT BE TREATED
Inform your treatment specialist if you have any of the above concerns, a history of herpes simplex, or are allergic to aspirin.
Unless otherwise instructed to do so by your treatment specialist:
POST TREATMENT GUIDELINES
It is crucial to the health of your skin and success of your treatment that these guidelines be followed:
I hereby give my consent & authorization, and voluntarily release...
from any claims implied or stated that I have or may have in the future with this treatment, regardless of result. I am stating that the treatment and precautions above have been explained to me in detail and that I fully understand. If I am under the care of a physician, I have discussed the treatment plan with my physician for prior approval