Facial Sculpting

Aquagold fine touch consent form


Aquagold fine touch micro-channeling creates superficial “micro-channels” to the outermost layer of the skin. This enables the absorption of custom ingredients to be infused directly into the skin by bypassing the skin’s natural protective barrier. Aquagold fine touch nourishes, feeds, heals and rejuvenates the skin from within.

These micro channels are created by patented 24ct gold hair fine, spiral thread needles. These delicate needles are so gentle your clinician is able to treat right to the lash line and over the lips. Depending on your skin concerns and the cocktail of ingredients mixed by your clinician: Aquagold fine touch micro-channeling addresses dryness, reduces the visibility of acne scars, fine lines, and wrinkles, reduces pigmentation, pore size, redness and improves the skin’s overall tone and texture. Micro channels also induce new collagen production.

I (Print Name) hereby authorise and direct to perform my Aquagold fine touch treatments.

I understand possible side effects include and are not limited to: slight to moderate redness, slight swelling, mild stinging. The treatment is mostly painless but can be tender over certain areas, such as the forehead, close to the eyes and over the lips. I UNDERSTAND THAT I SHOULD ONLY APPLY PRODUCTS RECOMMEDED BY MY CLINICIAN POST TREATMENT.

Most side effects will gradually diminish within 10 minutes to 1 hour.

Notify your clinician PRIOR TO SIGNING THIS CONSENT if any of the following apply to you:

  • Cold sores(or history), warts, open skin lesions, sunburn, extreme sensitivity, dermatitis, rosacea

  • Blood thinning medications

  • Pregnant or breastfeeding

  • Received chemotherapy or radiation therapy

  • Collagen Vascular Disease

  • Eczema, Psoriasis, or Dermatitis

  • Hemophilia / bleeding disorders

I am undergoing treatment of my own free will. I agree that this procedure is being performed for cosmetic reasons and that no guarantee can be made as to the exact results of this procedure. Although the results can be seen immediately I have been informed that there are no guarantees for expected results.

ACKNOWLEDGMENT

BY MY SIGNATURE BELOW, I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THE CONTENTS OF THIS AQUAGOLD FINE TOUCH CONSENT FORM AND THAT THE DISCLOSURES REFERRED TO HEREIN WERE MADE TO ME.

Date:  

 

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Signed by Nina Bal
Signed On: 11th January 2020

Signature Certificate
Document name: Aquagold fine touch consent form
Unique Document ID: 62a43e7a95a95c75d652c849aff7be7b9fd99c85
Timestamp Audit
5th November 2019 11:39 am BSTAquagold fine touch consent form Uploaded by Nina Bal - info@facialsculpting.co.uk IP 51.179.98.227