Advanced Esthetic Treatments

The Zemits DERMELUXX Hydrodiamond is a non-invasive fluid dermabrasion treatment. The unique vaccum powered exfoliation applicator pulls in the skin tissue to clean and deliver active serums due to skin type and condition, the oxygen handpiece delivers serums to the skin, and the cooling wand soothes the skin.

Please read all statements and sign below:

I have read the DERMELUXX Hydrodiamond Treatment Information and Instructions and have had an opportunity to ask questions about the procedures and treatment.

The DERMELUXX Hydrodiamond Treatment cost has been discussed with me, and I agree to pay the amount stated. 

I duly authorize Christine's in the Glen-Erin Linden to perform Zemits DERMELUXX Hydrodiamond Facial Treatment on me.

I understand that:

The goal of Hydrodiamond Facial is to hydrate and deeply cleanse the facial skin, which will improve cases of texture, uneven skin tone, acne and acne scarring, and overall health of the skin.

Every person is unique, which means skin condition and results may vary.  This makes it difficult to pinpoint an exact number of treatments that will be needed. Results may vary from individual to individual and amount of acne as well as amount of sun exposure also effect results.

DERMELUXX Hydrodiamond Facial treatments are recommended every one to two months, depending on the skin type and condition for optimal results.

DERMELUXX Hydrodiamond Facial may be performed any time before special events.

Slight pink or redness to the skin is normal and typically subsides within a few hours of finishing the treatment.

Skin irritation, bruising, or worsening of breakouts is an uncommon side effect, but may occur.

Not often, allergic reactions such as hyperpigmentation, hypopigmentation, and moles may occur and resolve themselves, but have the potential of being permanent. There is also the rare possibility of texture and scars, but can occur post-treatment. As any treatment, there may be unknown risks as of now.

I fully understand the effects explained to me.

What to expect:  

After DERMELUXX Hydrodiamond Facial treatment, its possible to feel slight irritation, tightness, and/or redness. These are all common reactions which typically resolve themselves within 48-72 hours post-treatment.

You may experience the following sensations within a few hours after DERMELUXX Hydrodiamond Facial: irritation in the area that's been treated.

As every individual's experience is different, some clients may experience these symptoms delayed.

The majority of DERMELUXX Hydrodiamond Facial clients can see immediate results after their treatment. Skin may feel hydrated and supple for a few weeks depending on proper at-home maintenance care.

After a DERMELUXX Hydrodiamond Facial Treatment, the skin needs to be protected from UV rays and possible sun damage. Please avoid excessive sun exposure and use at least an SPF 40 sunscreen.

I fully understand the effects explained to me. 

 Medical Information - Services Must be postponed if any of the following apply.  

Botox or dysport injections within the past 2 weeks 

AccutaneAny Facial Waxing within the past 7 days (not including eyebrow wax)

Cancer or post-cancer treatments, active skin abrasions or lesions, Retin A within 7 days of treatment.

Blood thinner medication

Laser procedure within the past 2 weeks

Chemical peel within past 2 weeks

Skin bleaching creams

Viral Infection/influenza/cold sore

 Services may still be provided at our discretion. 

Autoimmune Disease, Lupus, HIV, Epilepsy, or Hepatitis

Allergies

Eczema / psoriasis

Diabetes

Injections or Fillers within the past 2 weeks

Epilepsy

High / Low Blood pressure

Lymphatic disorder

Thyroid Condition

Rosacea

Stage 3 or 4 acne

Under Medical Care

If you answer Yes to any above contact Erin Linden for further questions/discussion.

I acknowledge all of the following:

It is my responsibility to avoid waxing, lasers, aggressive exfoliation, and products containing any retinoids or glycolic acids on the treated area for at least 2 weeks prior to and after my treatment.

I consent to having my photograph taken before, during, and/or after my treatment and authorize them to be anonymously used for the purposes of education (before/after) and promotion.

I will inform my esthetician, should my medical condition change during the course of treatment.

Risk of side effects can increase with immunocomprimised conditions such as HIV, Diabetes, Lupus or being on immunosuppresant medication which can cause increased risk of infection and improper healing.  I do not have any of these conditions.

By signing below, I certify that I have asked all of my questions and have read/fully understand the context of this consent form.

  Microchanneling Informed Consent  
Microchanneling is an elective procedure for cosmetic purposes only. No specific results are promised. Christine's in the Glen-Erin Linden has explained to me the nature, goals, method, limitations, risks and possible complications during and after the Microchanneling procedure. I understand that there may be a certain amount of discomfort or pain associated with the procedure and that other possible adverse side effects may include minor and temporary bleeding, bruising, peeling, scabbing, redness or other discoloration, and/or swelling, as well as rare side effects such as infection and scarring. I have had the opportunity to discuss alternative forms of treatment and understand that results may vary depending on individual factors such as medical history, sun damage, textural problems, skin type, and my compliance with pre- & posttreatment instructions. Fever blisters may occur on the lips following lip procedures in individuals prone to this problem. Pre-treating the area with prescription-strength anti-viral medication is advised. Secondary infection in the area of the procedure is rare if properly cared for but may occasionally occur. By initialing and signing below, I specifically acknowledge that I have been advised of the facts and matters in this consent form, and I agree as follows: (Please initial the line next to the number after you clearly understand each statement) 
 1.- I certify that I do not have any of the following contraindications, which could make me ineligible to receive a Microchanneling treatment at this time: Pregnancy or nursing Diabetes (unstable) Active herpes simplex in the area to be treated Dry skin in the area to be treated Any active inflammatory skin condition in the area to be treated, e.g. eczema, psoriasis, infection, rash or any type of dermatitis 
 2.- I have informed the practitioner of any and all of my known allergies. I acknowledge that it is not always reasonably possible to determine in advance whether I might have an allergic reaction to any of the topical preparations, serums or processes used in the procedure; and I agree to accept the risk that such reaction is possible.
 3.- I acknowledge that complications as a result of Microchanneling procedures may occur, particularly in the event that the post-procedure care instructions are not followed and accept full responsibility for such complications.
 4.- I realize that my body is unique and neither Christine's in the Glen-Erin Linden nor its employees or contractors can predict how my skin may react as a result of the procedure. 
 5.-I consent to the admittance of authorized observers to the procedure(s) for the purpose of education or assistance. 
 6.-I acknowledge that obtaining Microchanneling is my choice alone, and I consent to the procedure and to its attendant risks, and to any actions or conduct of Christine's in the Glen-Erin Linden and its employees and contractors reasonably necessary to perform the procedure.
 7.-I consent to any relevant photographs being taken both before and after the procedure, to document the results of the procedure strictly for the internal use of Christine's in the Glen-Erin Linden.
 8.-[Optional/Requested] I consent to Christine's in the Glen-Erin Linden using non-personally identifying before & after photos of me for marketing purposes to display its capabilities and results. If I do provide consent, I may at any time withdraw such consent for specific photographs by contacting Christine's in the Glen-Erin Linden, which will then discontinue use of said photo(s). 
 9.-I have been given the full opportunity to ask Christine's in the Glen-Erin Linden any and all questions which I might have about obtaining Microchanneling procedures, and all of my questions have been answered to my full and total satisfaction.
 10.-I agree that I will not be under the influence of alcohol, recreational drugs or other substances at the time of treatment. I have read and understand the contents of each statement above. I acknowledge that this is a contract and that I have received no warranties or guarantees with respect to the benefits to be realized from, or consequences of, the aforementioned procedure(s). I further acknowledge that at the time of signing this consent I am of sound mind and capable of making independent decisions for myself. I hereby release and forever discharge and hold harmless Christine's in the Glen-Erin Linden, ProCell Therapies, and their owners, managers, employees and affiliates from any and all claims, damages or legal actions arising from or connected in any way with my Microchanneling, or the procedure and conduct used in my performing the procedure, to the fullest extent allowed by the law.
If you have and questions or discussions, please contact Erin Linden 951-203-0965