Anamnesis and consent form for medical aesthetic treatments and facial treatments

Face treatments EN

Personal data

Medical data 


Customer expectations

Skin analysis / How does your skin feel?

Factors that may adversely affect the outcome

° Menopause
° Stress
° Hormone treatments
° Excessive exposure to the sun or sunbed
° Recent aggressive skin treatments eg laser

Not recommended for/by:

° Pregnant women (unless specific treatment)
° Cancer patients (unless specific treatment)
° People with heart problems
° Coagulation disorders (haemophilia, use of anticoagulants)
° Severe or active acne
° Rosacea/couperose or inflammatory skin processes
° Overly sensitive skin
° Facial herpes or active skin infection
° People treated with Roaccutane 6 months before treatment

Side Effects:

° Redness
° Itching
° Slight swelling
° Dryness
° Burning sensation
° Local bleeding
° Flaking of the skin
° Tight feeling

What to avoid before treatment:

° Excessive exposure to the sun and the sunbed for 14 days before treatment
Recent laser treatment or other aggressive treatments
 Local autoimmune treatments or treatments that cause hypersensitivity of the skin for 24 hours before treatment
Blood thinners (Asaflow, CardioAspirin, clopidogrel, ...)
° Fish oil, garlic and ginseng 1 week before treatment
° Use of Botox and fillers 21 days before treatment
° Recent chemical peelings
° 2 days before treatment heat (sauna, steam bath, etc.)

Recommendations after treatment:

° Do not apply makeup for 24 hours
Avoid overexposure to the sun and the solarium for 14 days
Avoid heat (sauna, steam bath, ...) 1 week after treatment
Do not apply aggressive hygiene products, lotions with alcohol or AHAs for 24-48 hours after treatment
Do not use exfoliating products for 7 days after treatment.
Do not do any intensive physical activity for 24 hours after treatment