PREVIOUS INFORMATION DOCUMENT FOR FACIAL TREATMENTS

Date_______________________

D./Ms.________________________________________________, with ID number_________________________, home address

in____________________________________________________________, phone.________________/____________
email________________________________________________.

Authorization of treatment

I request and authorize to helped by the staff

qualified that I need, perform the treatment of:

Radiofrequency Microdermabrasion Peeling Ultrasounds

Mesotherapy Electrostimulation Phototherapy Microneedles

Observations:

2. Description of the treatments

This document provides general information about treatments, explains the risks, benefits, effects
secondary and possible complications.

Radiofrequency Contraindications
It is a technique that consists of applying a current In cases of pregnancy and lactation, heart conditions
electromagnetic. This generates a lift of graves alterations of the coagulation
temperature internal favoring like this
the diseases del tissue and
restructuring of collagen and elastin, contributes neuromuscular, cancer, carrier patients of
to eliminate toxins, activates peripheral circulation, metal prostheses, pacemakers and defibrillators.
softens scars, expression lines, and has a
Side effects
rejuvenating effect.
At the end of the treatment, a slight
The number of necessary sessions is variable and will
redness or swelling that will disappear in a
depend on the condition of each patient and the level of
short period of time. It happens rarely.
demand of it, but they are considered necessary
between 4 and 10.
some small ecchymosis in areas of fragility
hair

Virtual Mesotherapy Contraindications

It consists of the emission of a low current. If suffering from acute intestinal infection, cancer,
intensity that increases the permeability of the skin, heart disease, pacemaker, diabetes
opening your pore and allowing the principle hypertension, allergies, inflammation of veins,
active applied to the surface penetrates to the dermis skin alterations during pregnancy.
wrinkle filling, reduction of bags,
dark circles and skin tightening. Side effects

The number of sessions will depend on each person and Intolerance to any of the active ingredients
thickness of adipose tissue. With an average of 2 to 10 it can produce a minimal local allergic reaction.
sessions. A slight redness or swelling may occur.
that will disappear in a short period of time.

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Microdermabrasion Contraindications
It is the application of microparticles that remove the It is not recommended for patients with active rosacea,
dead cells with a gentle abrasion, promotes the capillary fragility, vascular lesions, vulgar acne,
refinement of the stratum corneum of the skin, the herpetic lesions, ulcers or skin erosions,
removal of dead cells, smoothing y eczema, psoriasis, systemic lupus erythematosus and
diminishing scars, marks, and expression lines. diabetes mellitus.

The number of sessions will depend on the type of Side effects

the skin, at least five are usually necessary
The risks and complications are few erythemas,
sessions to have a lasting effect. The
petechiae, low risk of hyperpigmentation
the application frequency should be once every
postinflammatory, if these symptoms were to arise
weekly or every two weeks according to the objectives
generally disappear over a span of
persecuted. hours.

Electrostimulation Contraindications
Microcurrent electrical impulses what In the following cases, epilepsy, problems of
they produce a contraction of the muscles. circulation, neurological disturbances, irritation
Favoring the tone of these and the reaffirmation of skin, burns or wounds, diseases that
from the skin. affect muscle metabolism, syndrome
metabolic and inflammatory pathologies.
The number of sessions will depend on the age of the
client and skin type are considered necessary Side effects
between 6 and 10.
On rare occasions, redness can be observed,
erythemas, small burns y dystonia
muscular.

Ultrasonic peeling Contraindications

High-frequency mechanical vibration that produces It is contraindicated in cancer, pregnancy, and breastfeeding.
the elimination of the stratum corneum and allows the infections and open wounds, prosthetics in the area a
introduction of active ingredients into the skin. treatment and heart problems.
Improving its condition and acting on Side effects
wrinkles, scars, and acne marks.
Sometimes after the treatment it is possible to
The number of sessions varies according to the treatment.
observe, stinging, redness, and peeling of
carry out and the recommendations of the professional.
the skin. These effects will disappear within a few hours.

Phototherapy Contraindications
Procedure that is performed through light In patients with polymorphous light eruption,
(Photothermolysis selective about the tissue solar urticariamedication with effects of
determined by part del spectrum photosensitization,pregnancy and breastfeeding, injury
electromagnetic. Different pathologies are addressed. pigmentary, cancer, and Phototypes V and VI.
cutaneous: rejuvenation, acne, and spots.
Side effects
A number of sessions from 2 to 10 is established.
Edema and purpura may occasionally occur.
there are cases where less will achieve the
blisters, inflammation, of a transient nature.
desired results, and in others, in which they will do
needs some more.

Ultrasound Contraindications

Therapy that generates internal heat through the People with pacemakers or heart diseases, cancer,
ultrasounds, causes a skin contraction pregnancy and lactation, thrombophlebitis, disorders of
instantaneous and stimulates collagen production. sensitivity, open wounds and trauma
recent.
The number of sessions will vary according to the skin type and
state of the same. A minimum of being necessary Side effects
2 and a maximum of 6.
There may be slight redness, swelling.
tingling, sensitivity to touch, sense of
muscle pain that quickly alleviates.

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Microneedles Contraindications

It consists of tiny titanium needles that perform Patients undergoing anticoagulant treatment,
micro skin punctures producing a moles, warts, infections, open wounds, acne
activation of the epidermis, of the circulatory system and in an active state, tendency to create keloids,
of collagen regeneration. eczema, psoriasis, corticosteroids, pregnancy and
lactation.
The number of sessions is variable depending on
each person, it is recommended a series of 3 to 5 Side effects
treatments to achieve optimal results.
At the end of the session, erythema will occur in the
skin, sensation of heat and a slight tingling in the
treated areas, which will be sent in due course of the
hours.

3. Declarations

I confirm that I have been explained in detail, in words understandable to me, the effect and nature of the procedure.
to be done.

I assume full responsibility for any consequences of the treatment outcome.

I have not omitted or altered any data regarding my current health status that contraindicates the procedure, especially the
referring to allergies, illnesses or personal risks.

I authorize that photographs of the intervened area be taken to document the progress of the treatment.
understood that its use does not constitute any violation of the privacy or confidentiality to which I am entitled.

If at any time my state of health changes, I will inform you immediately before each new session.

I declare that I will follow the pre and post-treatment instructions to the letter and I take responsibility for the
consequences of omitting such instructions.

All the questions that I have freely asked about everything have been satisfactorily answered.
procedure, thus in good conscience I sign this consent.

Observations

Legal Representative (Tutor) __________

Company:

ID Card

Company:

The company is the Responsible party for the processing of the personal data of the Interested party and informs them that this data will be processed in accordance with
the provisions of Regulation (EU) 2016/679 of April 27, 2016 (GDPR), which provides you with the following information regarding processing.
Data retention criteria: they will be kept as long as there is a mutual interest in maintaining the purpose of the processing and when it is no longer needed.
necessary for this purpose, will be suppressed with appropriate security measures to ensure the pseudonymization of the data or total destruction of
the same. Data communication: the data will not be communicated to third parties, except by legal obligation. Rights of the Interested Party: Right to
withdraw consent at any time. Right of access, rectification, portability, and deletion of your data and the limitation or opposition
to its treatment. Right to file a complaint with the Control Authority (agpd.es) if you believe that the treatment does not comply with the
current legislation. Contact details to exercise your rights: Company, address and email. To carry out the data processing described,
The data controller needs your explicit consent or that of your legal representative. The interested party consents to the processing of their data.
in the terms set out.

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