BDR Consent Form

Please read each section of our consent form.

Description of the Procedure

bdr’s exclusive effect is immediate and visible. The procedure may include Lactic and Glycolic peel, Enzymatic Peel, Salicylic acid toning, Mechanical peel, Microperforation, Electrostatic polarization massage, and LED therapy in cooperation with active ingredients in bdr OTC (over the counter) dermaceuticals (ask for bdr ingredient list). bdr inclusively treats all skin types and conditions including oily, dry, allergy prone, rosacea, atropic, sensitive and irritable.

bdr treatments affects the epidermis to rebuild the broken skin structure (collagen fibres) with various stimulation and penetration of oxygen and active ingredients. The procedure enhances blood circulation, removes toxin build-up and removes dead skin layers. Healthy and natural skin resurfacing is induced without damaging blood or lymphatic vessels. Therefore, the skin continues to visibly improve up to 7 days after the treatment. Using bdr home-care products enhances and prolongs the effects of the bdr treatments.

bdr mechanical methods are safely performed with single use tips in sterile packaging. The procedure is performed without numbing cream or a steamer, and it does not require downtime.

Acknowledgement

Due to the time constraints and the nature of the Facial Treatments at this show, I understand that I must make every effort to let the aesthetician know of my skin condition and type and area of concern. The aesthetician won’t be able to do a full assessment of my skin and I will be fully responsible for any contraindications resulting from the Facial Demo. I understand that any of the following complications can occur through administration of the treatment:

DISCOMFORT: This is usually minimal and of short duration.

SWELLING: Rarely occurs and usually is minimal and subsides within a few hours or days.

REDDENING: A red discoloration may persist from a few hours to a few days (very rarely longer).

CRUSTING/SCABBING: On rare occasions, a superficial crusting may occur – this is localized, but can be seen over larger areas.

PIGMENTATION: Although extremely rare, temporary and possibly permanent - usually very mild and changes in color in skin may occur.

INFECTION: Infection is extremely unlikely, buy may occur. An outbreak of fever blisters may occur in affected individuals. Please inform your Aesthetician if you have a history of this

  • I Understand that a very small percentage of people may get a slight reaction from the wand that is used in some of the procedures.
  • I Understand that the results of this treatment may vary due to conditions such as age, condition of skin, sun damage, damage due to smoking, climate, etc.
  • I Understand that the number of treatments is dependent on skin type and condition and that the best results are achieved when an advanced and professionally advised program is followed.
  • I Understand that waxing, collagen injections and Botox injections should be avoided for at least 7 days if not more, before and after this treatment.
  • I Understand that direct sun exposure, including tanning booths is prohibited while I am undergoing treatment and that the use of daily sun block prevention (minimum SPF 30) to the area treated is mandatory.

I acknowledge that no guarantee has been made about the results of the treatment. Although it is impossible to list every potential risk and complication, I have been informed of the possible risks and complications which may include, but are not limited to, the following:

  • Stinging, itching, irritation
  • Redness and swelling of the skin
  • Tightness, peeling or scabbing of treated skin and the surrounding areas
  • Prolonged skin sensitivity to environmental elements
  • I understand I may or may not actually peel, that each case is individual and peeling does not correlate with the success or lack of the treatment

I attest that I have had an opportunity to ask questions and have had questions answered to my satisfaction.

I hereby certify that I am over the age of (18) and that:
  • I am not pregnant or breastfeeding (if receiving more intensive treatments)
  • I have not used isotretinoin in the past 12 months
  • I do not have a history of radiation to the treated area
  • I do not have active herpes simplex or active infection
  • I have not waxed in the past week or shaved the treated areas for atleast 24 hours
  • I have not used Retin A or similar medications for at least 4-5 days or longer
  • I have not used benzoyl peroxide for one week
  • I understand that to achieve maximum results, I may need several treatments
  • I WILL protect my skin from direct sun for 3 days atleast post procedure
  • I WILL use a broad spectrum sunblock every day and reapply when necessary
  • I WILL avoid hot baths/showers, tanning beds, sweating and strenuous exercise for at least 3 days post procedure
  • I WILL avoid rubbing, picking and scrubbing my skin post procedure, for I understand it could lead to scarring
  • I WILL NOT use retinoids or other exfoliation agents until my skin is healed

I have read and will follow to the best of my ability any and all instructions. I understand the potential risks and complications, and choose to proceed after careful consideration of the possibility of both known and unknown risks, complications, limitations and alternatives.

I grant bdr beauty USA, its rep and employees the right to take photographs/video of me and authorize them to the right to use and publish the same in print and/or electronically. I agree that bdr beauty USA may use such photographs/video with or without my name for any lawful purpose, including publicity, illustration, advertising and Web content.

Client Printed name :
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Date :
Aesthetician Signature :
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