Consultation Form

Skin Consultation

Under the requirement of the Public Health Act 2010 (NSW) you declare that you are not suffering from, nor are a carrier of any communicable diseases, including Hepatitis B, and Acquired Immune Deficiency Syndrome (‘AIDS’).

Your dermal specialist will recommend the appropriate treatment(s) and procedure(s) to address your skin concerns and goals. Your dermal specialist may recommend that you contact your general practitioner for referral to a dermatologist or similar specialist to assist with the achievement of your skin improvement goals.

Every skin corrective method and procedure involves a certain amount of risk, and it is important that you understand the risks associated with skin correction. An individual’s choice to undergo a corrective procedure at Sydney Dermal Lounge Pty Ltd, Dermal Lounge Australia Pty Ltd, Dermal Lounge Rouse Hill Pty Ltd or its related entities (‘SDL’) should involve a comparison of the risk of undergoing the corrective procedure to the potential benefit that may result. Whilst the majority of clients do not experience any complications, you should discuss the potential risks and complications with your dermal specialist to make sure you understand the risk and potential complications associated with skin correction. By consenting with your signature, you are stating that you understand all risks involved and consent to work with your dermal specialist in the case that any should arise.

It is for each individual to consider the risk to benefit in undergoing any of our procedures. Although most procedures do not carry any long term side effects, it is important that you consider and understand these risks. The below is a list of potential complications. This list is not exhaustive. If you have concerns in relation to any of the potential risks, you should discuss this with your dermal specialist or your general practitioner before proceeding with your procedure.

The products that we use are of the highest quality. The use of any of these products will only be as recommended by the manufacturer. However, depending on your skin type and your skin sensitivity, you may experience:

  • Reddening of the Skin
  • Swelling
  • Itching
  • Rash
  • Hypersensitivity
  • Chapped or dry lips
  • Photosensitivity

In the most extreme of cases, you may suffer burns. This list is not exhaustive of the potential side effects that you may experience. Contraindications that may apply to certain laser and vitamin A modalities include but are not limited to:

  • Pregnant, recently pregnant, or breastfeeding women
  • Women who are actively trying to fall pregnant
  • Clients with pacemakers, stents, or any implants to do with heart valves
  • Clients using skin-thinning or sun-sensitive medications (i.e. roaccutane)
  • Clients who have undergone surgery within 6 months (dependant on healing)
  • Clients with liver disease or malfunctioning liver
  • Clients with kidney disease or malfunctioning kidneys
  • Clients with cancer or who are currently undergoing cancer treatment
  • Clients with diabetes (type 1)
  • Clients with high fever
  • Certain medications (please check with your therapist)

The below conditions are also possible contraindications which may require medical clearance prior to performing your treatment, however your dermal specialist will advise whether this is necessary during your consultation:

  • Clients with a history of cancer
  • Clients with vascular diseases
  • Clients who have undergone a medical transplant
  • Clients with autoimmune conditions
  • Clients with a medical transplant in the treatment are
  • Clients with Thrombosis and/or Thrombophlebitis

The below conditions may only be contraindications if the condition is in the treatment area:

  • Carriers of large metal prosthesis in treatment area
  • Clients with a medical transplant in the treatment area
  • Clients with a tendency to keloid scar tissue in the treatment area
  • Clients with a hernia in the treatment area
  • Clients with any open wounds on or near treatment areas
  • Clients with an infection or skin sensitivity to treatment areas

Possible Side Effects of Treatments
The possible side-effects of our treatments can include:

  • redness
  • bruising
  • skin sensitivity
  • numbness
  • swelling
  • discomfort
  • blistering
  • dryness.

You may also experience possible discomfort during the treatment of laser modalities, resurfacing peels, injection therapy, and topical agents.

Factors That May Hinder Results Of Treatments
The below conditions may hinder the results of treatments:

  • stress
  • hormones and hormonal changes
  • medications and supplementation
  • diet
  • pregnancy and breastfeeding
  • pre-existing medical/other conditions
  • medical history
  • age (slower healing times)
  • allergies
  • sun exposure
  • lack of following instructions and incorrect product usage
  • sleep patterns
  • external influences

Recommended Treatments & Results
The treatment plan and number of treatments that have been recommended during the consultation appointment should be followed to obtain the results that the individual seeks. Results may vary from person to person due to factors such as individual medical history, body composition age. SDL does not guarantee results.

Whilst our treatments are devised to deliver results, they are best combined with a well maintained and healthy diet and lifestyle. In order for us to deliver exceptional service and measure your results, all clients are required to conduct body composition scans. This will provide our dermal specialists with greater detail about your individual needs and characteristics. Should you choose not to undertake a body composition scan, this will hinder our ability to assess your results as you progress through your treatment, or alter your treatment plan as needed.
You acknowledge that the best results cannot be obtained with only one treatment and our recommended treatment plan/pathway should be followed. Results can take time and can be seen from as little as 4-6 weeks of undergoing treatment and gradually over the following 8-12 weeks post-treatment. Failure to follow our recommended treatment plan/pathway (including any pre/post care instructions) as directed will affect the results achieved.

Cancellations and Refunds

  • Treatments/procedures are not transferable to other individuals.
  • We require at least 24 hours’ notice to be given for any appointment cancellation.
  • If you cancel within 24 hours of your appointment or do not attend a booked appointment, we reserve the right to retain your deposit.
  • Refunds will be provided where required in accordance with the Australian Consumer Law. We want you to be a satisfied client so if our service or product is faulty, it may either be replaced or refunded. We do not refund for a change of mind.
  • In order for us to provide you with great service, it is fundamental that you provide all information requested by us and advise us of any factors that may affect your treatments. You also need to have realistic expectations of the results of treatment.

SDL Pathways

  • Pathways, including individual treatments under the pathway, are not transferable to other individuals.
  • You have the right to request a pause of your pathway for 24 months, during which time your pathway will remain on hold for you until you are ready to commence.
  • 24 hours’ notice is required for any appointment cancellations for treatments that are part of a pathway. If you cancel an appointment within 24 hours or do not attend the appointment, the missed treatment will be forfeited.
  • Refunds will be provided where required in accordance with the Australian Consumer Law. We want you to be a satisfied client so if our service or product is faulty, it may either be replaced or refunded. We do not refund for a change of mind.

Discontinuation of SDL Pathways

  • If you choose to commence a pathway, you must continue it in accordance with the appointed sessions set under that pathway. You cannot receive a refund for a change of mind and must complete these sessions.
  • Refunds under a pathway may only be provided as follows:
    – If our products or services provide you with a right in accordance with the Australian Consumer Law; or
    – If you provide us with evidence (medical reports/documentation) from a medical professional (i.e., GPs, Specialists, Dermatologists) which state that the pathway is no longer suitable for you. The evidence must be sent to SDL by email, post or hand delivered to SDL.
  • The balance of sessions under a pathway will be ceased after review of your medical professional’s opinion which must be to SDL’s reasonable satisfaction.
  • Any sessions previously completed under the pathway will not be refunded.
  • The balance of sessions under a pathway will be ceased after review of your medical professional’s opinion which must be to SDL’s reasonable satisfaction.
  • Any sessions previously completed under the pathway will not be refunded.

Image Release Consent – for clients 18 years of age or older ONLY
I consent to SDL taking and using my photographs, video or image or photographs and videos they take of me (‘My Image’) for the purposes of advertising, media publicity, publication, training or general display, including but not limited to publication on internet web sites, social media pages and any other publications released by SDL (‘Publication’). I may revoke this consent at any time by giving SDL written notice.
I waive any interest that I may have in the copyright to My Image now or at any future time and acknowledge that I am not entitled, nor shall in the future be entitled, to receive any payment or consideration in respect of the use of My Image by SDL.
I acknowledge that SDL cannot control the unauthorised use of My Image by persons not associated with SDL upon the Publication of My Image and I release and shall indemnify SDL against any loss, damage, costs, expense, or claim (including consequential loss) connected with the Publication of My Image.