User GuideHYDRAFACIAL MD® ELITE
™
34
CLIENT CONSULTATION AND RELEASE FORM
Please read carefully, complete, sign and date this form prior to your
procedure.
Name: _______________________________________________________________
Phone: (______)_______________________________________________________
Address: ____________________________________________________________
City: ___________________________ State: ______ Zip: __________________
Email: ______________________________________________________________
HydraFacial® BLUE/RED LIGHT THERAPY
LYMPHATIC/MASSAGE THERAPY WET DIAMOND (Medical Use Only)
MICRODERMABRASION
SECTION 1: MEDICAL INFORMATION
Absolute Contraindications
YES NO
Accutane or other similar medication
Autoimmune disease, HIV, lupus, hepatitis, scleroderma
Active infection in the treatment area
Melanoma or lesions suspected of malignancy
Active Sunburn
Pregnancy (medical-legal)
Breastfeeding (medical-legal, may increase skin sensitivity &
likelihood of PIH
Epilepsy contraindicated for LED light therapy
Relative Contraindications
Anticoagulants therapy (use lower settings)
Very thin skin
Other Aesthetic Treatments: Botox: wait 5-7 days; Fillers: wait
7-10 days; Peels: wait 30 days
Laser Treatments: wait until lesions heal & swelling & redness is
resolved
Other Concerns
Keloids: avoid direct contact
Rosacea, telangiectasia (use lower vacuum)
Unrealistic expectations
If you answered YES to any of the above questions, please explain:
________________________________________________________________________
______________________________________________________________________
Please list any known allergies:
________________________________________________________________________
User GuideHYDRAFACIAL MD® ELITE
™
7
SAFETY GUIDELINES
1. Ensure that all operators of the HydraFacial® System are trained and
licensed as required by the state or country. Do not operate the unit
before being trained. For any questions regarding training, call your
salesperson or Edge Systems.
2. Be sure to read the User Guide thoroughly before setting up the
system. If you experience mechanical and/or electrical di culties
with your unit, call Edge Systems Service Department at 800-603-
4996.
3. Always use a clean tip for each procedure. The HydroPeel® tips are
for single use only. Use for more than one procedure may result in
infection.
4. Reusing contaminated skin solution can cause harm to the client and
will void all warranties.
5. Skin solutions should not exceed the “Use By” date on the bottle.
Should any products (skin solutions) settle, please contact your dis-
tributor or Edge Systems.
6. In the event that a client experiences irritation, discontinue the use of
the skin solution immediately.
7. Always do a client consultation (see Appendix for example) to
determine if the client is a candidate for the procedure. Follow contra-
indication list as pre-determination for procedure.
8. Always begin procedure conservatively. Follow recommended
protocols and contraindications for skin type. Each client’s skin condi-
tions and sensitivity are di erent and suggested settings will vary
for each client. Do a sensitivity test on the neck by the earlobe and
increase or decrease the vacuum level as required. Skin conditions re-
quiring more aggressive vacuum settings are at operator’s discretion.
9. Do not work on sensitive areas such as the eyelids. Eyelids should be
closed at all times during the procedure and covered with protective
eyewear or damp cotton pads. Sterile eye rinse solution should be
available at all times to rinse the eyes.
10. Removing contact lenses prior to procedure is recommended.