Sofwave Ultrasound Consent Form

Full Name*

First NameLast Name

I hereby authorize Timeless Beauty Aesthetics, to perform the following procedure: SOFWAVE ULTRASOUND TECHNOLOGY

I acknowledge that no guarantee has been given by anyone as to the results that may be obtained.

I will follow all aftercare instructions as it is crucial to do so for good healing and to minimize the risk of complications.

I understand that there are many types of treatment for fine lines and wrinkles and that each has its own benefits, risks and potential side effects. The treatment with the Sofwave System requires a non-invasive, dermatological procedure performed by a healthcare provider who is trained on the use of this product.
By completing this Patient Consent Form, I am consenting to the treatment with the Sofwave System and
acknowledging that I have read and understood the following points and all information contained in this form, and
made an informed and careful decision to receive the treatment with the Sofwave System.

•The Sofwave System is used to treat wrinkles and fine lines on the skin.

•The procedure is non-invasive and uses an utrasound beam.

•The SofWave System delivers ultrasound energy to the skin. The heat from the ultrasound stimulates new collagen and elastin to form.

•I understand that there may be some discomfort during the treatment when the ultrasound beam is being delivered.
•My healthcare provider may choose to appy a topical anesthetic and/or administer nitrous oxide and/or nerve blocks and/or intramuscular Toradol to me before the procedure to minimize the pain.
Following treatment, there may be some redness and/or swelling on my face that may last for a few hours;
•there should be no pain when the procedure is completed while post-procedure discomfort or tenderness is
possible.
•My experience in receiving the treatment and the results of my treatment may be different from others.

While receiving treatment with the Sofwave System can provide potential benefits for me, there are also potential risks/complications associated with the treatment. These risks include, but may not be limited to, the
following:
o Burn
o Significant pain
o Tenderness
o Changes in skin pigmentation
o Persistent redness and/or swelling
o Ulceration/Erosion
o Bruising

For additional information about the Sofwave System, I can call toll free 1-855-sofwave or log on to
https://sofwave.com/

By signing below, I acknowledge that I have read the foregoing consent and agree to the treatment with its associated risks. I hereby give consent to perform this and all subsequent dermal filler treatments with the above understood. I hereby release Timeless Beauty Aesthetics from all liabilities associated with this procedure.*

Yes

Patient Signature

SIGNATURE

Date

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INFORMED CONSENT FOR SOFWAVE