Skin Booster Consultation and Consent Form

Client Details

Full Name: *

Date of Birth: *

Email: *

Contact Number: *

Medical History

Are you currently taking any medication? *

Please list: *

Do you have any allergies or intolerances? *

Please list: *

Are you currently (or possibly may be) pregnant or breastfeeding? *

Do any of the following apply to you? Please tick all that apply.

Recent (past 12 months) Facial Peel Recent (past 12 months) Laser Treatment Recent (past 12 months) Ultrasound-based Treatment Cutaneous Disorder Inflammation or Infection at or near the treatment site History of severe allergy or anaphylactic shock Autoimmune Disease

Do you have any other medical conditions? *

Please list: *

Have you recently been unwell? *

Which of the following were you unwell with? *

Please provide more detail: *

Emergency Contact Details

Emergency Contact Name: *

Emergency Contact Relationship: *

Emergency Contact Phone: *

Treatment Information

Skin Boosters is an alternative way to nourishing your skin, especially designed to deliver deep-skin hydration.

This means increasing hydration levels within the skin to deliver lasting moisturisation and improvements on the skin’s surface, creating a fresh and natural look.

The treatment involves hydrating microinjections of a soft, gel-like substance called Hyaluronic Acid (HA) into the skin, which improves the skin’s firmness, elasticity and radiance.

Skin Boosters can be used to treat a range of areas including the face, neck, décolletage and hands. They are most commonly used on the lower face, and are a perfect treatment for smokers' lines. Skin Boosters works to improve skin texture and hydration around the mouth, chin, and lower cheek.

From our twenties onwards the fibroblasts within the skin stop producing so much of the skin's own natural Elastin, Collagen and HA. Skin Boosters uses micro injections to stimulate the skin's fibroblasts and encourage increased production of the skin's natural moisturisers. This in turn increases cell turnover, which gives a lasting effect to treatment. The addition of HA acts as a plumping and firming agent, giving the skin a more youthful, radiant appearance from within.

Skin Boosters improves the skin's firmness, elasticity and radiance in a subtle and gradual way that is natural but noticeably invigorating. The micro injections stimulate the fibroblasts to produce more of the body’s own HA, Collagen, and Elastin, this means that the treatment has ongoing benefits beyond the course of treatment.

Before Treatment

During the initial consultation we will discuss your treatment expectations. After discussion of what you wish to achieve and assessment of your treatment needs, we can advise if Skin Boosters is suitable for you.

During Treatment

Skin Boosters is injected into the skin in small amounts using a very fine needle. Numbing cream can be used to make the procedure more comfortable. The treatment is quick, typically taking about 30 minutes. Treatment with Skin Boosters does not affect facial expression and the benefits can normally be seen over the following days.

After Treatment

Skin Boosters products are biodegradable, which means they will be naturally broken down by the body. To ensure an optimal and long-lasting result, a course of three treatments 4-6 weeks apart is recommended, followed by a maintenance treatment once every 6 months. Downtime following a treatment is minimal, and many clients are able to return straight to work.

Possible Side Effects and Risks

After Skin Boosters treatment some reactions may occur.

These include:

Redness
Swelling
Itching
Bruising
Pain
Tenderness

The reactions are generally mild to moderate and usually disappear shortly after injection. They typically resolve spontaneously within one or two days.

If you have any concerns please do not hesitate to contact us or seek medical advice.

Consent

Please read each statement carefully and tick to show your agreement. *

I accept that any treatment I am going to receive is at my own risk. I certify that I have read and fully understood and completed this form to the best of my knowledge. I understand that failure to disclose information requested above may result in adverse side effect(s) and therefore I accept full liability/responsibility for the information given. The treatment(s) and possible side effect(s) have been fully explained to me. I accept full responsibility for the treatment given and complications which may arise or result during or following any procedure that is performed at my request. I accept that if I am not satisfied with the treatment I will inform the therapist and/or request to speak to the manager during or immediately following the treatment. I fully understand the above and consent to the Skin Booster treatment to be carried out.

Client Signature: *

Tap or click on the signature above to sign