Facial Consent Form

Consent to treatments Performed by North East Skin Care Clinic Esthetician. 

I authorise North East Skin Care Clinic esthetician to perform treatments on me. I understand that the procedures are purely elective and performed by licenced Esthetician.

I understand that: serious complications are rare, but possible. Common side effects include temporary redness and mild “sunburn” like effects that may last a few hours to 3-4 days or longer.

Other potential risks include, but not limited to: rashes, blistering, crusting, itching, pain, bruising, skin whitening, burns, infection, scabbing, scarring, swelling, and failure to achieve the desire result.

I understand that the sun exposure or use of tanning lamps or something or self tanning creams and not adhering to post – care instructions provided to me may increase my chance of complications.

Before and after treatment instructions have been discussed with me. I have read and understand the attached exclusionary criteria. The procedure as well as potential benefits and risks have been explained to my satisfaction. I have had all my questions answered.

Dr Yvonne Kangong

Family Physician

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