NuEra Tight Consent Form

NuEra Tight is a non-invasive procedure that emits radiofrequency (RF) that gently heat the skin and surrounding tissue. Induced heating of body tissues may provoke various physiological and thermoregulatory responses, such as reduction in the appearance in cellulite.

Treatment Course:
In all cases, your treatment course will be set and defined in accordance to our recommendation. Number of treatments are usually between 4-6 treatments in accordance to the treatment area and the desired clinical outcome. Treatments sessions scheduled at least 1 week apart and no more than 3 weeks apart for optimal results.

What to expect during treatment:
A treatment probe responsible for emitting the RF energy placed over the targeted area; as a result, you may feel varying degrees of heat. You may also feel an achy or sore feeling after treatment that can last between 24-48 hours. After treatment, you may experience:
• Erythema, or general tissue redness and irritation, is common and may present for few hours after treatment
• Some clients show results after the first treatment, and other patients take a little while longer.
• You can expect full results in up to 8 – 12 weeks to appear.

The treatment requires clients meet a basic inclusion criterion to minimize general risk.
Please answer the following questions truthfully to ensure you are a candidate for treatment.

Does any of the following apply to you?

Rows	Yes	No
Taking medicines that increase skin sensitivity to heat
Taking medicines that change skin metabolism
Cancer or pre-cancerous lesions in the treatment area
Herpes simplex in the treatment area
Risk of keloid scars
Pregnancy
Pacemaker wearers
Significant concurrent skin conditions or any inflammatory skin conditions
Active cold sores, open lacerations or abrasions
Chronic or cutaneous viral, fungal, or bacterial diseases
Anticoagulant therapy
Active local or systemic infections
Any disease in which a temperature increase is contraindicated

By signing this document, you are confirming that all known potential side effects
have been properly explained, which include:
Warmth and mild pink to redness skin - usually disappear after treatment.
Mild diarrhea, transient erythema and a mild shock similar to a static discharge
(Mostly due to an excessive heating or lack of full contact with tissue).
The treated area mildly swollen immediately after the treatment.
Before and after pictures taken as part of the treatment.
These pictures may be used for marketing purposes with all identifying information is removed.

I have read the above information, and I give my consent to be treated with the NuEra Tight procedure by

Client Name

First NameLast Name

Client Signature

Date