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Hifu 3 in 1 Sample Consent Form.

Areton Ltd presents this document as a template for the convenience of its customers only and not any other party. It is strongly recommended you consult your insurer and your legal consultants before using this document (amendments may be required). Areton Limited does not assume any responsibility for any inclusions, mistakes or omissions within this document. It is advised to keep a signed copy for your record and one should be handed out to the client.

 

WHAT TO EXPECT DURING AND AFTER YOUR HIFU TREATMENT

• You can expect to experience some discomfort as the ultrasound energy is delivered. Your Aesthetic Practitioner will agree a plan to optimise 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.

POSSIBLE SIDE EFFECTS FROM 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 have read the above and consent to receiving the treatment at my own discretion.

Client’s signature: ………………………………….. Date: ………………………

 

PHOTOGRAPHS

I authorise the taking of photographs and video footage which will be retained as a private record for the clinic and practitioner.

Client’s signature: ………………………………….. Date: ………………………

 

I ALSO CONSENT THE USE OF MY PHOTOGRAPHS AND VIDEO FOOTAGE FREE OF CHARGE FOR MARKETING PURPOSES.

Client’s signature: ………………………………….. Date: ………………………