I, the undersigned, pledge to inform of all changes in my physical condition.
I agree to undergo the treatment, as detailed below in this document. I was explained to and I understood the results, the chances and the course of the treatment.
I confirm that I do not suffer from any of the above described conditions.
I have had the opportunity to consider the following information, ask questions and have had these answered satisfactorily by my esthetician, Maria Sanchez.
* You are being treated with the Geneo+ platform for anti-aging and/or skin lightening treatments. The platform works with OxyGeneo Technology.
* Special gel will be applied on your face and the treatment will be performed using an applicator with a special capsule attached to it.
* During the treatment the reaction between the capsule and the gel will cause the infusion of the active ingredients.
* The treatment is none invasive, pleasant and does not require down time. I understand that receiving the course of treatment is my choice.
I was told about the possible side effects of the treatment including: excessive redness or swelling, itching, irritated skin, scratches, visible capillaries, sensitivity to touch, change of pigmentation, chance of transient skin break out such as pimples, allergic reaction. Although these effects are rare and expected to be temporary, any adverse reaction should be reported immediately.
I hereby approve use of the photos and results for scientific publications and marketing material (such as brochures, website, and presentations). These publications should be done while maintaining my privacy and identification.
I confirm that I have read and understand the above information and consented to the treatment out of my own free will.