Venus Bliss Consent To Treat Form

This Informed Consent has been prepared by Beauty By Kitten to help inform you about the the potential benefits, associated risks and alternatives of the Venus Bliss Laser Treatment. During your consultation and medical assessment Beauty By Kitten should have reviewed with you the potential benefits, associated risks and alternatives of the Venus Bliss Laser. They will have also provided you with answers to any and all questions you may have had about the procedure. If you have any remaining questions or concerns about the potential benefits, associated risks or alternatives of the Venus Bliss Laser, do not sign the consent without speaking to your service provider.

The Venus Bliss Laser is a comprehensive, safe and effective platform system integrating laser technology to address issues with unwanted fat. The system integrates a 1064nm diode, which delivers laser energy to subcutaneous tissue layers for fat specific lipolysis. Automated “build” and “sustain” heating cycles to ensure comfortable temperature elevation and sustaining throughout the treatment exposure.

By receiving Venus Bliss Laser treatments, you may benefit from fat tissue reduction in the treatment area. When discussing the potential benefits of the Venus Bliss with you, Beauty By Kitten may have shown you a variety of before and after images. It is important to remind you that these images were used as an educational tool to allow you to visualize the general range skin improvements that may be achieved with your proposed treatment; the before and after images are not meant to be guarantees of actual or exact outcome.

Every cosmetic procedure involves a very small degree of risk and, although exceedingly uncommon, it is important that you understand and accept the rare risks involved with the Venus Bliss Laser. An individual’s informed decision to undergo any cosmetic procedure is based upon a comparison of the risks against the potential benefits, alternatives and costs.Although the vast majority of Venus Bliss Laser patients never experience any of these complications, you should discuss each of them with Beauty By Kitten to ensure you fully understand the alternatives, risks, potential complications and average outcomes of the Venus Bliss Laser treatments.

• Blisters – in rare cases a blister may occur as a result of the treatment. In this instance, Beauty By Kitten may recommend treatment of the blister. Slight tenderness in the treatment area lasting several weeks, in this instance, ice packs may be applied.
• Swelling – edema, swelling of the skin, is common and will resolve in a few days. Edema may occur as early as immediately post treatment and as late as a few days post treatment. It is advised to seek a consultation and follow up appointment with Beauty By Kitten should you require medical attention or have concerns.
• Redness in the treatment area which may last for several weeks.
  Other side effects which may be observed, but are extremely rare include, but not limited to, skin contour irregularities, dimpling of skin, numbness, hypopigmentation/hyperpigmentation, asymmetry, itching, rash changes in skin laxity, and necrosis (tissue death).

Possible side effects related to the contact cooling in the treatment area include tingling, itching, decreased sensation, numbness, redness and tenderness.
There are many variable conditions, in addition to risks and potential complications listed above, that may influence the long-term result from the Venus Bliss Laser. Even though risks and complications can occur infrequently, the risks cited in this booklet are particularly associated with the Venus Bliss Laser. Other complications and risks can occur but are even less common. Should complications occur, additional procedures or treatments may be necessary. The practice of aesthetics medicine is not an exact science. Although good results are expected, there is no guarantee or warranty, expressed or implied, as to the results that may be obtained. Infrequently, it is necessary to perform additional treatment to improve your results.

Female patients must not be pregnant nor wishing to become pregnant for the duration of the treatment program.

Informed Consent forms are used to communicate information about the proposed treatment of a condition along with disclosure of risk and alternative treatment(s). The informed consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients in most circumstances.

What Beauty By Kitten has discussed with you and has been included in this form are the material risks both common and uncommon that Beauty By Kitten feels a reasonable person would want to know, understand and consider in trying to decide if the proposed treatment of a condition is something they would like to proceed with. However, Informed Consent forms should not be considered all-inclusive in defining other methods of care and risk encountered. Beauty By Kitten may provide you with additional or different information that is based on all the facts in your particular case and the state of medical knowledge Informed-consent documents are not intended to define or serve as the standard of medical care. Standards of medical care are determined on the basis of all of the facts involved in an individual case and are subject to change as scientific knowledge and technology advance and as practice patterns evolve.

It is important that you read the above information contained on this and all preceding information carefully and have all of your questions answered by Beauty By Kitten before signing the consent at the bottom of the page.

1. I hereby authorize Beauty By Kitten and/or such assistants as may be selected to perform the Venus Bliss procedure and/or treatment.

2. I recognize that during the course of the procedure/treatment unforeseen conditions may necessitate different procedures than those above. I therefore authorize the above physician and/or assistants or designees to perform such other procedures that are in the exercise of his or her professional judgment necessary and desirable. The authority granted under this paragraph shall include all conditions that require treatment and are not known to my physician at the time the procedure is begun.

3. As part of the requirements of the Beauty By Kitten my chart may be subject to a peer review for quality control.

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

5. I consent to the photographing or televising of the procedure(s) to be performed, including appropriate portions of my body, for medical, scientific or educational purposes, provided they do not reveal my identity. These photographs and videos may be used for medical meetings, advertising, or any promotional or public relations purposes.

6. For purposes of advancing medical education, I consent to the admittance of observers to the treatment room.

7. I understand that the signature of the witness (if a non-physician) on this document indicates only that the signing of my name has been observed and not that the witness has necessarily provided information regarding the procedure.

8. IT HAS BEEN EXPLAINED TO ME BY MY PHYSICIAN AND/OR ASSISTANTS IN A WAY THAT I UNDERSTAND:
THE ABOVE TREATMENT OR PROCEDURE TO BE UNDERTAKEN
THERE MAY BE ALTERNATIVE PROCEDURES OR METHODS OF TREATMENT
THERE ARE RISKS TO THE PROCEDURE/TREATMENT PROPOSED
ANY QUESTIONS I MAY HAVE ASKED HAVE BEEN ANSWERED TO MY SATISFACTION

I understand that factors like, Alcohol intake and medical conditions can slow and or stop my results all together! I understand that water intake is essential to the process. 

I have read this release form and confirm that all the information I have given on this document and the Customer Health History form is correct and to follow the General After Care Instructions. I understand that this is a release form and I agree to be legally bound by it.