Medical Aesthetics Bar

Dermafuse — Consultation & Consent Form

Client Information

Treatment Description — Dermafuse

Dermafuse is an advanced microneedling and skin rejuvenation system designed to:

• Improve skin texture, tone, and elasticity

• Reduce fine lines, wrinkles, and superficial scars

• Stimulate collagen and elastin production

• Enhance absorption of serums and active ingredients for deeper results

This treatment is non-surgical and minimally invasive. Multiple sessions may be recommended depending on the client’s skin condition and desired results.

Pre-Treatment Instructions

1. Avoid tanning, sun exposure, or self-tanning products for at least 2 weeks prior.

2. Avoid Retinol, chemical peels, or exfoliating treatments in the treatment area for 3–5 days prior.

3. Disclose all medications, allergies, or medical conditions.

4. Arrive with a clean face, free of makeup, creams, or oils.

Post-Treatment Instructions

1. Mild redness, swelling, or tenderness may occur and usually resolves within 24–72 hours.

2. Avoid direct sun exposure; apply broad-spectrum SPF 30+ once healed.

3. Avoid harsh skincare products (retinol, acids, scrubs) for 3–5 days.

4. Keep skin hydrated and follow any post-care regimen provided.

5. Avoid intense heat exposure (saunas, steam rooms) for 24 hours.

Consent & Liability Acknowledgment

I, the undersigned, acknowledge and agree that:

1. I am voluntarily receiving Dermafuse treatment at Medical Aesthetics Bar and understand the nature, purpose, and potential risks.

2. I have provided complete and accurate medical history, including allergies, medications, implants, previous surgeries, or history of cancer.

3. Results vary by individual, and no guarantees or warranties are made regarding outcomes.

4. I have read, understood, and agree to follow all pre- and post-treatment instructions.

5. I release, indemnify, and hold harmless Medical Aesthetics Bar, its owners, employees, and contractors from any liability, claims, or damages arising from the treatment, except in cases of gross negligence or willful misconduct.

6. Photographs may be taken for documentation, treatment comparison, or educational purposes, with my consent while maintaining confidentiality unless otherwise authorized.

Acknowledgment: