HIFU CONSENT FORM

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HIFU CONSENT FORM

You can expect to experience some discomfort as the ultrasound energy is delivered. Your Aesthetic Practitioner will agree a plan to optimize your comfort during the procedure. HIFU treatment is efficient. For example, a treatment for the full face and neck will last approximately 40-45 minutes.

Laser light could cause serious eye injury; protective eyewear must be worn during treatment.

POSSIBLE SIDE EFFECTS OF HIFU TREATMENT
Your skin may appear red for a few hours after HIFU treatment.

You may experience slight swelling, tingling or tenderness for a few days after treatment. Rarely, some people may experience temporary bruising welts or numbness.


There is a slight risk of a burn to the skin, which may or may not lead to scarring. Both a burn and any scarring will respond to medical treatment.

Temporary nerve inflammation will resolve in a few days or weeks. If a motor nerve has become inflamed, you might experience some temporary local muscle weakness. There could be some temporary numbness if a sensory nerve has become inflamed.

DECLARATION
I have read and understood all the information provided and I have had the opportunity to ask any questions concerning the nature of the treatment, its expected results, and its possible risks and complications.

It has been explained to me that the results of HIFU treatment can vary from person to person. I am aware that occasionally the collagen that builds in the deep layers of the skin, providing support for the skin structure and helping to counter the effects of gravity, might not have a visible effect on the surface of the skin.

I also understand that the results will be seen gradually over a period of 3 to 6 months and that some people will benefit from more than one treatment.

I understand that HIFU treatment is a non-invasive treatment. It is not designed to produce the same results as an invasive surgical procedure.

I understand and agree that I am financially responsible for the payment I made for that any amount I paid for the sessions or procedures I booked it will only be valid up to 3 months from the date I made the payment. I understand that I need to utilize the sessions or procedures within 3 months period. I agree that my payment made is non-refundable or non-transferable post this period.

I declare that I have read and fully understood all points in this consent and that all of my questions were answered to my satisfaction and I take the full responsibility of my decision in this consent.

 

Patient Name & Signature :   

Doctor/Therapist Name & Signature :   

Witness Name & Signature :     

Parent or Gaurdian Name (if patient is minor) :

Date :

Consent to be photographed and published

I, , consent to be photographed and published on Social media, by while before and after the procedure. I further authorize that the photographs may be published for any purpose and in any form.

Patient Name & Signature :