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Consent Form

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

Your details

Dermaplaning, treatment information & disclaimer

Dermaplaning uses a sterile blade to gently exfoliate the surface of the skin and remove fine vellus hair (peach fuzz), leaving the skin smoother and brighter and improving the appearance of fine lines and a makeup base. It is not an exact science and no specific result can be guaranteed; occasionally no visible improvement is seen and another treatment may be advised.

The procedure is mildly abrasive and you must follow your practitioner's instructions. As with any treatment there are risks including irritation, redness and, rarely, reaction or infection. Please disclose any relevant condition or medication before treatment.

I acknowledge I have the right to discontinue treatment at any time, and that I am over 18 (or have signed parental consent). I will inform the clinic of any concerns as soon as they occur.

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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