I confirm that I consent to receiving JetPeel treatment.
I understand that the JetPeel system is used to treat various skin, scalp, and body conditions.
I understand that JetPeel is a treatment that can be used to provide lymphatic drainage, hydra dermabrasion, chemical peeling, and infusion of solutions according to skin condition. JetPeel system uses a handpiece that accelerates liquids that are sprayed into the skin in a safe and effective manner. I understand that a complete cycle of 4-6 treatments, spaced a week apart, may be needed to achieve optimal results.
I understand that clinical results may vary depending on individual factors, including, but not limited to medical history, skin type, patient compliance with pre/post procedure instructions, and individual response to treatment.
I understand that in rare cases there is a possibility of short-term effects, such as reddening, mild burning, temporary slight swelling of the sin, rash and tingling especially during the
exfoliation, as well as the possibility of rare side effects such as scabs, discoloration or individual allergic reaction to ingredients of the solutions. These effects have been fully explained to me.

I understand there must be at least the following window of time lapsed before a JetPeel treatment:

• Fillers 4-weeks || Botulinum toxin A injections – 3 weeks
• Electrolysis 1-week || Micro needling – 1-3 days

I certify that Ihave been fully informed of the nature and purpose of the procedure,
expected outcome, and possible complications. understand that no guarantee can be given
as to the results obtained. Iam fully aware that my condition is of cosmetic concern and the
decision to proceed is based solely on my expressed desire to do so. Ihave informed the
practitioner and staff regarding any current or past medical condition, disease, or
medication taken, and any allergic reactions.

I have informed the practitioner that I use systemic or topical retinoids.
I confirm that Idon’t have any contraindications for JetPeel treatment such as active infections, allergic reaction to cold temperature, metastatic disease, active skin diseases in acute stage, pregnancy, breastfeeding.

I certify that Ihave been given the opportunity to ask questions and all my questions have been answered and that I have read and fully understand the content of this consent form.
I accept al risks of treatment and agree to provide aftercare as directed by this facility.

JET TECHNOLOGY MUST NOT BE USED ON PEOPLE WITH:

• Disorders such an acute herpes, severe acne, acute dermatitis, or other active diseases of the skin.
• Active Infections
• Pregnancy, Breastfeeding
• Use of systemic retinoids (Accutane, Roaccutane, Isotretinoin, Amnesteem, Claravis, Sotret) or topical retinoids – Contraindication for exfoliation with Chemical Peeling
• Active Cancer – Contraindication for lymphatic drainage (must be 5 years cancer-free before starting lymphatic drainage)
• Fillers in the past month
• Botox (Disport, Xeomin) in the past 3 weeks.
• Micro needling in the past 1-3 days
• Electrolysis in the past 1week
• Allergic reaction to cold temperature

I have read and fully understand this information about contraindications. Iconfirm that Ido not have any contraindications from this list.

Pre- and post procedure follow-up instructions

BEFORE TREATMENT:

1. Do not apply topical retinoids 48 hours before treatment.
2. Ask about contraindications.
3. Remove makeup before beginning treatment.
4. Cover guest with warm blanket.
5. Cover guest’s ears with headband and gauze pads.

AFTER TREATMENT:

1. Do not apply topical retinoids 48 hours before treatment.
2. Recommend leaving solution on the face until bedtime and on scalp until the next morning
3. Avoid sweating – no sauna or gym – on this day.
4. Do not apply retinoids up to 24 hours after treatment.