PLEASE READ CAREFULLY AND SIGN WHERE INDICATED, ONLY when you are ready to proceed. Ensure all points below have been discussed with your practitioner. With your signature herein, you understand, acknowledge and accept these terms.

Terms of your treatment:
You have chosen a cosmetic procedure that is not medically necessary.
Fibroblast Plasma Tightening is an art process, not an exact science and cannot guarantee exact results due to skin elasticity and individual healing process.
You may be required to return for additional treatments before your overall procedure is deemed complete. The payment for any additional work, (if applicable), Additional treatments, cannot be performed until after 4-8 weeks from date of initial treatment. This is in order to allow the initially treated area to heal fully.

Your practioner will use a treatment plan to record the areas you have chosen, Numbing anesthetic will be used on treatment area, as well as pre and post treatment photographs. This information will be held securely in your consultation record.

The skin type of every client is different and the healing process may lead to some discoloration of the skin, particularly if exposed to sun while healing. After each treatment some swelling or redness may occur. In some cases there may be extreme swelling. Your practitioner will give you appropriate advice to help reduce this risk. Please follow this advice.

Throughout the treatment you may experience some discomfort, but your practitioner will reassure you throughout and endeavour to make you feel comfortable. Since the treatment includes small burns to the skin, you may experience the smell of charring. This is perfectly normal. You must adhere to the practitioner’s aftercare advice given to you following your treatment. This is very important and will reduce the risk of post procedural infection upon leaving the clinic. You must let the treated area heal properly. Avoid picking, plucking, knocking as this will hinder the healing process and could make the treatment appear uneven thus requiring further work.

I have voluntarily elected to undergo this treatment/procedure after the nature and purpose of this treatment has been explained to me, along with the risks and hazards involved, by Eva Sztupka-Kerschbaumer(esthetician).

Although it is impossible to list every potential risk and complication, I have been informed of possible benefits, risks, and complications and the potential for long-term permanent skin damage. I also recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require further treatments of the treated areas to obtain the expected results at an additional cost.

I have read and understand the post-treatment home care instructions. I understand how important it is to follow all instructions given to me for post-treatment care, especially regarding limiting my exposure to UV light. In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care, I will consult the esthetician immediately.

I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically.

I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I do not hold my Esthetician, Eva or ESSpa, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.

 

I understand the above and hereby consent to and authorize Eva Sztupka-Kerschbaumer (esthetician) to perform the Plasma Fibroblast Tightening Treatment: