ARETON LTD HIFU TREATMENT CONSENT FORM

Name: ……………………………………………………………..

email address: ………………………………………………………..

 

AVOID THIS AFTER PROCEDURE

1. Avoid direct sunlight following a clinical facial.
2. Wait 24 hours following a clinical facial before using Glycolic Acid and Retinoid products.
3. Avoid using scrubs or depilatories for 48 hours following the clinical facial.
4. Do not pick your skin following a clinical facial.
5. Avoid strenuous exercise for 24 hours following a clinical facial or body treatment.
6. If using Retinol products do not have facial waxing.

POST  HIFU TREATMENT EXPECTATIONS
You can expect to experience some discomfort as the ultrasound energy is delivered.

HIFU treatment is time saving. For example, a treatment for the full face and neck will last approximately 40-45 minutes.

 POSSIBLE SIDE EFFECTS OF HIFU TREATMENT

• 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 time saving. For example, a treatment for the full face and neck will last approximately 40-45 minutes.

 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.

You 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.

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.

I have read and understood the important information above and I will follow the guidelines specified.

Yes……….             No………

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

Yes……….             No………

I  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.

Yes……….             No………

A 24-hour rescheduling notice is appreciated and required. We realize emergencies happen and will be understanding if a last minute change arises; however, we reserve the right to charge full treatment price for missed appointments without a 24 hour notice.

Yes……….             No………

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.

Yes……….             No………

I agree to the terms of service and give consent for the use of my photographs and video footage  for record and future reference purposes and that complete patient confidentiality will be maintained.

Sign………………….       Date…………………

 

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