top of page

CONSENT FORM

Gender
Service Opted for
Check problem faced
Upload File
Check problem faced

I understand the improvement is directly proportional to the number of sessions that I will take. Sessions Result may vary from person to person & session suggested is the minimum required session to see -difference but 'not for getting complete cure of the skin problem".

refund by No in any circumstances is given for the session already taken (as already specified during consultation doctor). If treatment is converted to another treatment (example skin to hair). 20% of the total amount paid will be deducted; as the package was given on a discounted rate based on number of sessions. Also the amount for the number of session done will be deducted. The balance amount will be converted to other services.

I hereby authorize and request the availing of the services.I give my consent to any advice and necessary procedures, medication or anaesthetics to be administered by the attending person. I understand and acknowledge that I am financially responsible for the above mentioned services provided for myself.

I agree to share my feedback testimony in any kind written, picture, and video, any other to Diet Design/Derma Design. and I also here by consent to give and forever grant to Diet Design/Derma Design. the right of use of this testimony feedback for marketing purposes and the company can regular sms/ whatsapp/email/call updates on the mobile number registered with them.

I understand I may need further treatment by a specialist or even hospitalization if complication arises during the follow up treatment Alternative and possible reactions of these treatments have been explained to me clearly, in detail and in my language.

I am thankful to Diet Design/ Derma Design Consultants for analyzing my skin in so much detail helping me in improving my skin.

I understand the improvement is directly proportional to the no. Of sessions that I have taken though i was suggested more sessions. Result may vary from person to person session suggested is the minimum required session to see -difference but ‘not for getting complete cure of the skin problem”.

I have been made aware by the trainer/ staff that the procedure will be done with due care and the possible effects and Post

that care I have to take. I am taking the procedure/ treatment at my own will and risk & I will not hold responsible  the owner/ the associate owner or any staff of the Clinic for any the side effects/ Injury like redness swelling,

discoloration of skin, peeling, pain, bum, burning sensation, or mishap if any during the course of treatment. Further

complications like infection, hemorrhage, bleeding, scaring, contraction, possible deformities, prolonged healing time over the

estimate reaction to any drug before and during after surgery, numbness or Itching of the area have been clearly explain to me

If the client notices improvement in the above sessions she can join for more sessions for better results. No refund in any circumstances is given as the above sessions do not guarantee 100% results (as already specified during consultation by doctor ) .20% of the total amount paid will be deducted, if treatment is converted to another treatment (example skin to hair). Also the amount for the number of session done will be deducted. All the rest will be converted to other services
I Understand that the information provided will be used to send me timely 
reminders and updates on offers and other information

Home Care For Client ( Post Skin Treatment)

  • No washing face with water, soap, scrub, face wash or face packs for 2 days after the treatment and even on the day the treatment. 

  • Call the skin practitioner on the third day before washing your face report the condition of skin. 

  • Clean face with Skin tonic cotton. Do not rub on the face directly. 

  • Apply gel for 4 days. For 4 days sun block to be worn at all times. It gets worn out every three hours. Kindly re-apply after washing face between 10am-5pm. 

  • No scrubbing or applying products unless permission from consultant taken, else the skin will become red and peel more we will not be responsible. 

  • Session are once a week unless told to come once in 15 days .Session can be anywhere from ½ hour to 2 hours depending on your skin condition that day and the skin requirement according to the decision taken by your consultant.

  • After the treatment the skin becomes red for 2 days and peels (exfoliates) for 2 days. 

  • Kindly do not walk in the sun or ride on a bike. Travel in an auto or car with face covered.

  • Clean face with Skin tonic & cotton. Do not rub on the face directly. e da the treatment.

  • Do not wash face with soap, scrub, face wash or pack for 2 days after the treatment and even on the third day call the skin practitioner before washing your face & report the condition of skin.

  • Apply gel for 4 days. Wear sun block at all times while going out.

  • No scrubbing or applying products unless permission from consultant taken,

  • sessions are once a week unless told to come once In 15 days.

  • Session can be anywhere from ½ hour to 2 hours depending on your skin cottl~n. ( xfoliates) for 3 days.

  • Please note that generally after the treatment the skin becomes red for 3 days.

  • Klndly avoid sunlight. Ride on a bike to be avoided.

  • If traveling is necessary please cover your face.

_

Thanks for submitting!

bottom of page