• INFORMED CONSENT FOR IMAGE TREATMENTS

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  • * The treatment was explained to me in detail.

    * The benefits of what I can realistically expect to see from my Clinical Peel have been fully explained to me.

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  • PRECAUTIONS

    The treatment you will receive is a clinical treatment designed to exfoliate or remove the outer layers of the skin.

    Your participation in your skincare treatments will determine the outcome. It is important that you strictly adhere to your home care products that your aesthetician has recommended.

    No guarantee is expressed or implied as to the precise results, peeling times or discomfort.

    During the treatment, you may experience some temporary stinging or warm flushing. This will fade within a few minutes. During the next few hours, you may experience some tightening of the skin, which may last for several days.

    For most patients, flaking begins within 48 hours. It is impossible to pre-determine how much peeling will occur. The shedding process usually subsides within 5-7 days.

    Depending on the clinical peel performed and your skin quality, the following reactions may occur in some patients:

    1. Prolonged redness, irritation, and flakiness
    2. Dryness and sensitivity
    3. Severe allergic reactions in rare instances
  • Please read carefully and initial each statement:

    * I am not pregnant.**

    * I have not used glycolic acid for 24 hours.

    * I have not taken Accutane in the past year.


    * I agree not to pick, peel, or scratch the skin during the healing phase.


    * I agree there may be crusting and shedding of the skin.


    * A prior patch test has been given to me to rule out any allergic tendencies.


    * I agree that I currently do not use Hydrocortisone.

    * I do not have active cold sores.

    * I have not received radiation treatments.

    * I agree it is mandatory to use the Image post peel kit.

    * I agree to avoid direct sun exposure for 2 weeks.

    * I agree to notify the Doctor/Aesthetician of any concerns.

    * I agree to apply Image Prevention+.

    * I agree not to wax for 7 days pre/post treatments.

    * I agree to follow up with scheduled appointments.

    * I agree not to use Retin-A products 7 days pre/post treatments.

    * I am under the supervision of a physician and have discussed the treatment plan with my physician.

    **Exceptions: Ormedic Lift and Signature Lift are safe for pregnant women.

  • I hereby give my consent and authorization voluntarily and release Limitless Medspa from any claims, implied or stated that I have or may have in the future with this treatment, regardless of the result. I am stating that the treatment and precautions above have been explained to me in detail and that I fully understand.

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