LEGEND PRO™ Treatment Consent Form

LEGEND PRO™ Treatment Consent Form

Please complete this form to provide your informed consent for LEGEND PRO™ treatments.
Patient Information
Full Name
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact
Treatment Information
I authorize Unique European Skincare to perform LEGEND PRO™ treatments including, but not limited to:
• RF Microneedling
• Skin Tightening
• Texture Refinement
• Wrinkle Reduction
• Acne Scar Treatment
• Collagen Stimulation
Medical Contraindications Checklist

Please initial if you currently have or ever had any of the following:
Pregnancy or breastfeeding
Pacemaker or implanted electrical device
Active infection, cold sores, or open wounds
History of keloid scarring
Autoimmune disorders
Cancer treatment within the last 12 months
Accutane use within the last 6 months
Blood clotting disorders or blood thinners
Recent fillers, Botox, lasers, or peels
Diabetes or impaired wound healing
Acknowledgment of Risks

I understand that although LEGEND PRO™ treatments are generally safe, possible side effects and risks may include:
• Redness
• Swelling
• Temporary discomfort
• Dryness or peeling
• Bruising
• Hyperpigmentation or hypopigmentation
• Infection
• Scarring (rare)
• Reactivation of herpes simplex

Pre & Post Care Understanding

I understand and agree to follow all treatment instructions, including:
• Avoid retinol, acids, and exfoliation before and after treatment
• Wear SPF daily
• Avoid excessive sun exposure
• Avoid exercise, sauna, steam room, and hot showers for 24–48 hours
• Follow all aftercare recommendations provided by my provider
Photography Release
Consent & Signatures
No Guarantee

I understand that results vary from person to person and no guarantees have been made regarding the outcome of this procedure.

Consent

I certify that I have read and fully understand this consent form. I have had the opportunity to ask questions and all of my questions have been answered satisfactorily.
Signature
Date

MonthDayYear
Date
Should be Empty:

LEGEND PRO™ Treatment Consent Form

Patient Information

Treatment Information

Medical Contraindications Checklist

Consent & Signatures