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Patient Consent for DermaSweep Exfoliating Treatment

I hereby authorize Zanya Spa Salon to perform a DermaSweep Exfoliating Treatment. 

I understand that the following side effects or complications may occur:

1. Discomfort

2. Acne flare up

3. Transient spots of hypo or hyperpigmentation

4. Bruising

5. Redness and swelling for a period of 2 hours to 7 days

6. Itching or irritation

7. Skin peeling or flaking up to 7 days after the procedure

8. Infection

9. Herpes (fever blisters on the face and lip)

10. Rarely, scarring

I confirm I am not pregnant, I am not currently taking blood thinners, I have not used Accutane or other oral retinoid products in the past 12 months, and I have not used a topical retinoid (Retin A, Differin, Tazorac) in the past 2 weeks.

I have informed my skin care provider if I have any of the following conditions: history of pigmentation disorder, history of keloid scarring, active herpes simplex, recent peels or laser treatments, recent sun exposure, autoimmune disease, any surgery in the past 6 months.

I understand the DermaSweep procedure is a controlled process, but it is not an exact science and the results cannot be guaranteed. I acknowledge that no guarantee has been made by anyone regarding the results of this treatment that I have requested and authorized.  The technician has provided the information and answered all of my questions concerning this procedure.  I clearly understand the above information.

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