Facials
If you have any of the listed conditions below we will need a doctor’s note prior to receiving any services.
Any Autoimmune disease
Blood pressure medication
Cancer
Chemotherapy / radiation
Psoriasis
Serious Medical Condition
Cannot perform any services if you’ve been on accutane in the past 1 year.
Dermaplaning
Is a procedure that provides a light exfoliation to your skin getting rid of the dead skin and vellus hair (peach fuzz). This procedure involves the use of a sterilized surgical blade.
Contraindications- Although it is impossible to list every potential risk and complication, the following are recognized as known contraindications. Furthermore, it is your responsibility to fully and accurately disclose all medical history prior to initial treatment, as well as provide any necessary updates at all future treatment sessions. If you have any of the conditions listed below, you should bring it to the attention of your esthetician PRIOR to signing this consent form. Please review the following carefully. It is important that you answer all questions honestly and to the best of your ability and knowledge. Failure to do so can result in unsatisfactory results and/or injury.
Accutane within (1 year)
Active infection of any type (bacterial, viral, or fungal)
Blood thinner medications ( 2 weeks )
Botox (Discontinue 2 Weeks Prior)
Cancer (1 Year)
Chemotherapy or radiation (1 Year)
Cold Sores (2 weeks)
Compromised skin
Diabetes
Dermatitis
Eczema
Nickel allergy
Open lesions
Psoriasis
Retin A discontinue (Discontinue 3 days Prior)
Recent Skincare treatment (discontinue 2 weeks prior )
Sunburn / Sun exposure (Discontinue 2 Weeks Prior)
Waxing (Discontinue 2 Weeks Prior)
Post Care- Avoid Sun exposure for (14 days )
Avoid scrubs/exfoliants/ harsh ingredients for (3 days)
Retinol (3 days)
Stay hydrated
Use sunscreen daily
Facial
A facial is a procedure where we treat the face for concerns including acne, clogged pores, blackheads, dehydration, dead skin cell build-up, etc. The goal of a facial treatment as in any cosmetic procedure is improvement, not perfection. Extractions may be added to treatment to gently and safely remove blackheads, drain inflamed acne impactions, and release trapped ingrown hairs. A series of treatments is recommended for maximum results.
Contraindications- Although it is impossible to list every potential risk and complication, the following are recognized as known contraindications. Furthermore, it is your responsibility to fully and accurately disclose all medical history prior to initial treatment, as well as provide any necessary updates at all future treatment sessions. If you have any of the conditions listed below, you should bring it to the attention of your esthetician PRIOR to signing this consent form. Please review the following carefully. It is important that you answer all questions honestly and to the best of your ability and knowledge. Failure to do so can result in unsatisfactory results and/or injury.
Accutane within (1 year)
Active infection of any type (bacterial, viral, or fungal)
Blood thinner medications ( 2 weeks )
Botox (Discontinue 2 Weeks Prior)
Cancer (1 Year)
Chemotherapy or radiation (1 Year)
Cold Sores (2 weeks)
Compromised skin
Diabetes
Dermatitis
Eczema
Open lesions
Psoriasis
Retin A discontinue (Discontinue 3 days Prior)
Recent Skincare treatment (Discontinue 2 Weeks Prior)
Sunburn/Compromised skin (Discontinue 2 Weeks Prior)Waxing (Discontinue 2 Weeks Prior)
Post Care- Avoid Sun exposure for (14 days)
Avoid scrubs/exfoliants/ harsh ingredients for (3 days)
Stay hydrated
Retinol (3 days)
Use sunscreen daily
Foreverbyash Signature Facial
Contraindications- Although it is impossible to list every potential risk and complication, the following are recognized as known contraindications. Furthermore, it is your responsibility to fully and accurately disclose all medical history prior to initial treatment, as well as provide any necessary updates at all future treatment sessions. If you have any of the conditions listed below, you should bring it to the attention of your esthetician PRIOR to signing this consent form. Please review the following carefully. It is important that you answer all questions honestly and to the best of your ability and knowledge. Failure to do so can result in unsatisfactory results and/or injury.
Chemical Peel- A chemical peel is a technique used to improve and smooth the texture of the skin. Chemical peels are intended to remove the outermost layers of the skin. To accomplish this task, the chosen peel solution induces a controlled injury to the skin. This leads to stimulation of new collagen production and restructuring of old collagen bundles in the skin. Multiple sessions may be required based on the severity of the skin condition. A series of treatments is recommended for maximum results.
Dermaplaning- is a procedure that provides a light exfoliation to your skin and gets rid of the dead skin and vellus hair (peach fuzz). This procedure involves the use of a sterilized surgical blade.
Accutane within (1 year)
Active infection of any type (bacterial, viral, or fungal)
Blood thinner medications ( 2 weeks )
Botox (Discontinue 2 Weeks Prior)
Cancer (1 Year)
Chemotherapy or radiation (1 Year)
Cold Sores
Compromised skin
Diabetes
Dermatitis
Eczema
Laser hair removal (Discontinue 2 Weeks Prior)
Nickel allergy
Open lesions
Psoriasis
Retin A discontinue (Discontinue 3 days Prior)
Recent Skincare treatment (Discontinue 2 Weeks Prior)
Self Tanner, spray tans, and tanning beds (Discontinue 2 Weeks Prior)
Sunburn/Sun exposure (Discontinue 2 Weeks Prior)
Waxing (Discontinue 2 Weeks Prior)
Post Care- Avoid Sun exposure for (14 days)
Avoid scrubs/exfoliants/ harsh ingredients for (3 days)
Avoid raising body temperature (72 hours)
Makeup (24 hours)
Retinol (3 days)
Stay hydrated
Use sunscreen dailyVitamin C (72 hours)
Microdermabrasion- Microdermabrasion uses a diamond encrusted wand (or crystals) to remove superficial layers of the skin in the treated areas. The intensity of the procedure can be adjusted to your desired results and comfort level. Microdermabrasion is often used to treat acne, reduce the appearance of scars, wrinkles, hyperpigmentation and other skin conditions. A series of treatments is recommended for maximum results.
Contraindications- Although it is impossible to list every potential risk and complication, the following are recognized as known contraindications. Furthermore, it is your responsibility to fully and accurately disclose all medical history prior to initial treatment, as well as provide any necessary updates at all future treatment sessions. If you have any of the conditions listed below, you should bring it to the attention of your esthetician PRIOR to signing this consent form. Please review the following carefully. It is important that you answer all questions honestly and to the best of your ability and knowledge. Failure to do so can result in unsatisfactory results and/or injury.
Accutane within (1 year)
Active infection of any type (bacterial, viral, or fungal)
Blood thinner medications ( 2 week)
Botox (Discontinue 2 Weeks Prior)
Cancer (1 Year)
Chemotherapy or radiation (1 Year)
Cold Sores
Compromised skin
Diabetes
Dermatitis
Eczema
Open lesions
Psoriasis
Retin A discontinue (Discontinue 3 days Prior)
Recent Skincare treatment (Discontinue 2 Weeks Prior)
Self Tanner, spray tans, and tanning beds (Discontinue 2 Weeks Prior)
Sunburn/ Sun exposure (Discontinue 2 Weeks Prior)
Waxing (Discontinue 2 Weeks Prior)
Risks listed below are for each treatment listed above
Risks- Although it is impossible to list every potential risk and complication, these are some known risks. Furthermore, it is your responsibility to fully and accurately disclose all medical history prior to initial treatment, as well as provide any necessary updates at all future treatment sessions. I do understand that any hormone imbalance present within my anatomical system can alter the treatment. Please review the following carefully. It is important that you answer all questions honestly and to the best of your ability and knowledge. Failure to do so can result in unsatisfactory results and/or injury.
Pain- There may be a very slight burning, scratchy, and irritated sensation to the skin. This is usually temporary and is gone within a few hours after treatment. A sudden reappearance of redness or pain is a sign of infection and you should notify our office immediately.
Picking- Avoid picking and/or peeling the skin during the healing period as this can cause hyper/hypopigmentation. I understand that I should not have a chemical peel if I intend to continue to have excessive sun exposure.
Pigment/Color Change/Sun Exposure- Because dermal penetration extends into the layer of the skin containing melanocytes, hyperpigmentation can be common “darkening” of the skin this reaction is more common when treated areas are exposed to the sun and the client does not adhere to proper aftercare instructions.
Redness/Swelling- After the procedure, the skin will be red, with mild swelling and/or bruising, and your skin might feel tight and sensitive to the touch. It’s a normal part of the healing process. As long as you did not raise your body temperature or have sun exposure you should not experience these symptoms. If you have persistent redness or swelling please reach out to the office. Itching will be normal as the skin starts to peel.
Scarring- Although normal healing after the procedure is expected, abnormal scars may occur in both the skin and deeper tissues. In rare cases, thickened or keloid scars may result.
Allergic Reaction- A variety of products may be used on the face in conjunction with the procedure such as Jelly/Soothing/Restorative hydrogel/ calming mask, chemical peels and other chemical exfoliants and products your esthetician deems is best for your skin to which an allergy can occur. Additionally, since this procedure increases the penetration of topical substances, it can cause you to be hypersensitive to products used on the face. I do understand allergic reactions can occur, you must contact our office immediately or notify your esthetician of any abnormal feeling during the treatment. In rare cases you may be advised to contact your doctor.
Infection- Viral, bacterial, and fungal infections can occur anytime the integrity of the skin is compromised. In rare cases you may be advised to contact your doctor.
Lack of permanent results- I understand it may take multiple treatments to obtain optimal results.I understand I may not experience complete clearance, and that it may take multiple treatments. Some conditions may not respond at all and, in rare cases, may become worse. There is a possibility of a poor result from any cosmetic procedure. These procedures may induce undesirable results, including but not limited to skin sloughing, scarring, permanent pigment, and/or other undesirable skin changes. The treatment may not completely or permanently improve skin texture, tone, elasticity, hyperpigmentation, scars, or minimize fine lines and wrinkles. It is important that your expectations be realistic and understand the procedure has its limitations. Additional procedures may be necessary to achieve desired effect. No Refunds or Returns Due to the nature of the services and products provided, Foreverbyashh LLC and Ashley Holdings LLC, including their employees, independent contractors, subsidiaries, and affiliates (collectively, “Foreverbyash”) does not issue refunds for used or unused services and does not accept any product returns.
Nicks- Although it’s impossible to list every risk these are some known risks, mild redness, irritation, and dryness. Additionally, nicks to the skin can occur due to the sharp surgical blade. The hair that grows back will not be darker or thicker, however I do understand that any hormone imbalance present within my anatomical system can alter the normal hair growth pattern.
Liability release/acknowledgement- My signature below acknowledges that I have carefully read and fully understand the contents of this informed consent and release form. I understand that results can vary and that no guarantee, neither expressed nor implied, has been or will be given to me regarding my results. I am aware of the risks and benefits associated with this procedure, I've had the opportunity to consider alternative treatments. I understand this is an elective procedure, performed solely for cosmetic purposes, and is not critical to my health.I am hereby providing my informed consent to undergo the treatment and voluntarily assume all risks associated with the procedure. I hereby fully and forever release and discharge Ashley Holdings LLC and Foreverbyashh LLC, including their subsidiaries, owners, managers, employees, independent contractors, and agents (collectively, “Foreverbyash”), from any and all injuries, losses, damages, and claims, demands, lawsuits, expenses, and any other liability of any kind, either to myself or my property, arising out of or related to the treatment provided by Foreverbyash.
Photography Release- For purposes of this Photography Release, you are referred to as “the Client.” By signing the acknowledgement below, the Client consents to be photographed with the understanding that their picture could be used in the future of advertising without further compensation or permission. The Client understands their name will not be disclosed with the use of their picture without the Client’s consent.
By signing below, I, the Client, verify that: (1) I am eighteen (18) years of age or older; (2) I have read, understood, and agree to all policies, risks and contraindications (3) I have carefully read and answered all questions to the best of my knowledge. This form must be signed by an adult parent or guardian if the client is less than eighteen (18) years old. If applicable, by signing below, the undersigned parent and/or legal guardian does hereby acknowledge that he/she is aware of the dangers and the risks. I agree to use electronic records and signatures.
