Important Background to the Consent Process
Your clinician wishes to help you make an informed decision about your treatment options and any relevant alternative options. You may at any time decline treatment even after giving your consent.
Whilst your clinician will make every effort to understand what significance you would attach to any particular risk it is important to us that you feel comfortable enough to question the clinician on any point of concern during this process. Please feel you have as much time as you wish to reflect on the information given before agreeing to proceed with the treatment.
Purpose of Treatment
You have presented with concerns which have formed the basis of a clinical discussion and examination. The purpose of the proposed treatment is to address your concerns either individually or in combination with other modalities of treatment.
Your clinician will endeavor in good faith to employ the principles of best practice in delivering your treatment. Each patient is individual and response to treatment will vary from patient to patient and treatment to treatment. As such it is difficult to guarantee outcomes will always meet your expectations.
Every care is taken to deliver the products in a manner which will minimize risk, however you should be aware of the risks, as one may exist upon which you place particular significance.
Patients are advised to take in to account all these potential risks before consenting to treatment. Please make your clinician fully aware of your expectations prior to giving consent.
Model consent to treatment
I consent to acting as a model for the purpose of training (under supervision). The use and indications for the products that I will be treated with have been explained to me by the practitioner and I have had the opportunity to have all my questions answered to my satisfaction. I have answered the questions regarding my medical history to the best of my knowledge.
Training course times may be delayed due to unforeseen circumstances. It may take longer training the students or the student may need more support. So please allow extra time in case this event occurs. Your full payment for your treatment as a model is non-refundable. If the circumstances occur outlined above and/or cancellation your payment is non-refundable. The full payment will be made prior to attending the training academy.
Every procedure involves a certain amount of risk and it is important that you understand the risks involved. An individual’s choice to undergo a procedure is based on the comparison of the risk to potential benefit. Although most patients do not experience these complications, you should discuss each of them with your practitioner to ensure you understand the risks. Potential complications and consequences of – Dermaplaning – is a low-risk procedure. Side effects may include slight redness in your face in the hours after getting the treatment. Some people develop whiteheads on their skin in the day or two after dermaplaning. Infection and scarring are rare after dermaplaning, but they do occur.
I consent to Ampika’s Aesthetics using photographs photographs being stored on a training file and be used for social media purposes photographs and/or video recordings including images of me both internally and externally to promote the Training Academy. These images could be used in print and digital media formats including print publications, websites, e-marketing, posters banners, advertising, film, social media, teaching and research purposes. I understand that images on websites can be viewed throughout the world and not just in the United Kingdom and that some overseas countries may not provide the same level of protection to the rights of individuals as EU/UK legislation provides. I understand that some images or recordings may be kept permanently once they are published. I have read and understand the conditions and consent to my images being used as described.
I am signing to consent to my treatment being administered at Ampika’s Aesthetics. On behalf of the training academy Ampika’s Aesthetics - Ampika’s Hair Make Up and Beauty. You are agreeing to be a model and hold no responsibility towards Ampika’s Aesthetics for any procedures that may incur any personal dissatisfaction or cause of concern.
Any models wishing to seek any legal or liable action will not be permitted to do so once signing this disclaimer you are excepting full responsibility to allow a student to carry out your Dermaplaning Treatment.
These Students who are responsible for carrying out the treatment under medical supervision, are not fully qualified to carry out Dermaplaning unassisted. Therefore, you understand the risk that this may pose. Any concerns must be addressed whilst you are present in the training academy. Whilst all the trainers accommodate you to ensure you are fully satisfied with your treatment, we are unable to rectify problems weeks after you have undergone the treatment. If there are any concerns then please contact the training academy within 48 hours of treatment via email at [email protected].
Have you received chemotherapy or radiation treatment in the last year?
Do you have or have you ever had an allergic reaction to any of the following?
Please read these statements carefully:
Dermaplane is a non-invasive, low-risk treatment. In fact, it’s one of the safest skin rejuvenation treatments available today. Minor side effects include:
Each of these possible side effects is temporary and heals on its own.
This treatment is considered a “lunch hour procedure,” as it doesn’t require any downtime. Most patients are immediately able to resume their normal activities. However, these are a few skin care practices that should be put into place following a dermaplaning treatment:
As long as you remember to do the things mentioned here, and any other skin care regimens your provider recommends, you will see amazing results.
Results Of Dermaplaning
Just like with any skin treatment, results will vary with each patient. That said, initial benefits of the procedure are visible immediately upon completion. But remember that for years and years, your skin has been accumulating damage. Regular maintenance treatments are recommended for optimal results. Your skin didn’t lose its glow and vitality after one day, and cells simply can’t regenerate completely after one dermaplane treatment.
If any unforeseen condition arises in the course of this procedure(s), calling in his/her judgement in addition to, or different from those now contemplated, I further request and authorise him/her to do whatever he/she seems advisable and necessary in the circumstances.
By signing this form you have agreed to consent to adhere to our vaccination policy.
Please sign below to state that you have read and understand the information associated with the risks of dermaplaning facial therapy above:
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Signed by Ampika Pickston
Signed On: June 9, 2021
If you have questions about the contents of this document, you can email the document owner.
Document Name: Dermaplaning Consent
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