Informed Consent and Treatment Authorization Information.
This document represents the informed consent for the ULTRAcel Q+ HIFU Body Treatment to be conducted at Elen Rivas Beauty Clinic. Please carefully review and understand the information provided herein before proceeding with the treatment.
1. Introduction
I, [Patient's Name], acknowledge that I have voluntarily chosen to undergo ULTRAcel Q+ HIFU Body Treatment at Elen Rivas Beauty Clinic after carefully considering the information provided to me. I have had the opportunity to ask questions and have received satisfactory answers. I understand the nature of the ULTRAcel Q+ HIFU Treatment and the potential risks and benefits associated with it.
2. Procedure Objective
The objective of the ULTRAcel Q+ HIFU Body Treatment is to improve the appearance of my skin by tightening and lifting sagging skin, reducing cellulite, and improving overall skin texture and tone. The treatment aims to give me a more toned and rejuvenated appearance.
3. Procedure Description
During the ULTRAcel Q+ HIFU Treatment, advanced ultrasound and radiofrequency technologies will be used to deliver energy to specific areas of my body. This energy will target the deeper layers of the skin, stimulating collagen production and promoting skin tightening and lifting. The procedure is non-invasive and typically requires minimal downtime.
4. Expected Results
The benefits of ULTRAcel Q+ HIFU Treatment may include tighter and lifted skin, reduced cellulite, improved skin texture, and overall rejuvenation. However, individual results may vary depending on factors such as skin type, age, and the severity of skin laxity.
5. Risks and Side Effects
While ULTRAcel Q+ HIFU Treatment is generally safe, there are certain risks and side effects associated with the procedure. These may include:
- Temporary discomfort may occur during the procedure, including a mild stinging, tingling, or warming sensation. This discomfort usually subsides shortly after the treatment.
- Redness and swelling in the treated areas are common side effects. These are typically mild and subside within a few hours to a few days. Applying a cold compress can help reduce these symptoms.
- Bruising can develop in some cases, usually minor and fading within a week.
- The treated skin may become more sensitive than usual, resulting in increased sensitivity to touch, temperature changes, and skincare products. This sensitivity usually resolves within a few days.
- Pigmentation changes may occur, including hyperpigmentation (darkening) or hypopigmentation (lightening). These changes are usually temporary but can be permanent in rare cases.
- Post-treatment dryness and flaking can happen as part of the healing process. Keeping the skin moisturized is essential to alleviate these symptoms.
- There is a rare risk of infection if the treated area is not kept clean. Following post-treatment care instructions carefully minimizes this risk.
- In rare instances, blisters or burns can develop on the treated skin. This can occur if the energy settings are too high or if the skin is not adequately prepared for the procedure. Proper care and following post-treatment guidelines can help prevent these complications.
- While uncommon, there is a slight risk of scarring, particularly if the skin is prone to keloid formation. Patients with a history of keloid scarring should inform their practitioner before treatment.
- Some patients might experience temporary muscle weakness in the treated areas, usually mild and resolving within a few days.
- Occasionally, headaches can occur following the treatment. These are generally mild and can be managed with over-the-counter pain relief.
- Temporary numbness or altered sensation in the treated areas may happen. This side effect usually resolves on its own within a few days to weeks.
- Some patients may experience temporary skin sensitivity or irritation.
- Rarely, mild skin burns or blisters can occur.
- Patients may experience slight discomfort from sitting still during the procedure.
- Mild redness or swelling may appear in the treated area.
6. Alternative Treatment Methods
I understand that there are alternative treatments available for skin tightening and rejuvenation, including surgical body lifts and other non-invasive procedures. However, I have chosen ULTRAcel Q+ HIFU Treatment after discussing the options with my clinician and determining that ULTRAcel Q+ HIFU is the most suitable treatment for me.
7. Contraindications and Precautions
I acknowledge that ULTRAcel Q+ HIFU Treatment is not suitable for everyone and that there are certain contraindications and precautions to consider. These may include:
- Pregnancy or breastfeeding
- Active skin infections or inflammatory skin conditions
- Recent use of certain medications or treatments
8. Procedure Process
The process of providing the service consists of the following main stages:
- Initial consultation with a specialist to assess skin condition and determine suitability for ULTRAcel Q+ HIFU Treatment.
- Signing of Informed Consent and discussion of treatment plan.
- Pre-treatment skin preparation, which may include avoiding sun exposure and certain skincare products.
- Application of a topical anesthetic to enhance comfort during the procedure.
- Administration of ULTRAcel Q+ HIFU Treatment using a handheld device that delivers ultrasound and radiofrequency energy to the skin.
- Post-treatment assessment and application of soothing creams or lotions.
9. Contact Information for Feedback
If I have any feedback or concerns regarding my ULTRAcel Q+ HIFU Treatment, I can contact the clinic at [Clinic's Contact Information] for assistance.
10. Photo Consent
I consent to the use of my before-and-after photos for documentation and promotional purposes.
11. Patient's Responsibilities Before the Procedure
Before the ULTRAcel Q+ HIFU Treatment, I will:
- Follow any pre-treatment instructions provided by the clinic.
- Inform the clinic about any medications or health conditions.
12. Patient's Responsibilities After the Procedure
After the ULTRAcel Q+ HIFU Treatment, I am responsible for:
- Following post-procedure care instructions provided by the clinic.
- Monitoring my skin for any unusual reactions and reporting them to the clinic.
13. Post-Procedure Care Instructions
Proper post-treatment care is crucial to achieve optimal results and minimize the risk of complications. I agree to follow all post-treatment instructions provided by the clinic, including the use of recommended skincare products and sun protection.
14. Important Procedure Information
I understand that the ULTRAcel Q+ HIFU Treatment may require multiple sessions for optimal results, and the interval between sessions will be determined by the clinic based on my skin's response to the treatment.
15. Consequences of Refusing the Procedure
I understand that refusing the ULTRAcel Q+ HIFU Treatment may result in the persistence of my skin concerns and may limit the improvement in my skin's appearance.
16. Specialist's Qualifications and Experience
The ULTRAcel Q+ HIFU Treatment will be performed by a qualified specialist who has received training and certification in ULTRAcel procedures.
17. Patient Rights
I have the right to ask questions, seek a second opinion, and make informed decisions about my care.
18. Confidentiality of Information
All my personal and medical information will be kept confidential and will only be shared with authorized personnel involved in my care, unless required by law.
19. Procedure Duration
The ULTRAcel Q+ HIFU Treatment procedure typically takes [duration] minutes/hours to complete, depending on the size of the treatment area and the complexity of the skin condition.
20. Preparation for the Procedure
Before the ULTRAcel Q+ HIFU Treatment, I will:
- Avoid sun exposure and tanning beds for [duration].
- Discontinue use of certain skincare products as advised by the clinic.
- Arrive at the clinic at the scheduled time with clean skin, free of makeup, creams, or lotions on the treatment area.
21. Opportunity to Ask Questions
I have had the opportunity to ask questions about the ULTRAcel Q+ HIFU Treatment, and all my queries have been answered to my satisfaction by the clinic's staff.
22. Guidance on Behavior During the Procedure
During the ULTRAcel Q+ HIFU Treatment, I will be asked to remain still and follow the specialist's instructions to ensure the accuracy and safety of the procedure.
23. Information on How the Patient Can Expect to Feel During and After the Procedure
During the ULTRAcel Q+ HIFU Treatment, I may feel a warm or prickling sensation as the ultrasound and radiofrequency energy are applied to my skin. After the procedure, I may experience temporary redness, swelling, or tingling in the treated area, which should subside within a few days.
24. Recovery Expectations
I understand that the recovery time after ULTRAcel Q+ HIFU Treatment may vary depending on the intensity of the treatment and my skin's response. I can expect to resume normal activities immediately after the procedure, although I may need to avoid sun exposure and certain skincare products for a period advised by the clinic.
25. Consent for Storage and Processing of Personal Data
I consent to the clinic storing and processing my personal and medical information for the purposes of providing ULTRAcel Q+ HIFU Treatment and maintaining my medical records. I understand that my information will be kept confidential and will not be disclosed to third parties without my consent, except as required by law.
26. Clinic's Commitments to the Patient
The clinic is committed to providing me with safe and effective ULTRAcel Q+ HIFU Treatment in a professional and caring environment. The clinic will ensure that all staff involved in my care are properly trained and qualified to perform the procedure.
27. Procedure Planning Details and Timelines
The clinic will provide me with a detailed treatment plan, including the number of sessions required, the interval between sessions, and the expected timeline for achieving the desired results.
28. Information on the Possibility of Treatment Plan Changes
I understand that the treatment plan may need to be adjusted based on my skin's response to the ULTRAcel Q+ HIFU Treatment. Any changes to the treatment plan will be discussed with me, and my consent will be obtained before proceeding.
29. Payment and Refund Details
I understand that payment for ULTRAcel Q+ HIFU Treatment is due at the time of service. The clinic accepts [accepted payment methods]. Refunds may be provided in accordance with the clinic's refund policy.
30. Instructions for Contacting in Case of Questions or Issues
If I have any questions or concerns about my ULTRAcel Q+ HIFU Treatment, I can contact the clinic at [Clinic's Contact Information] for assistance.
31. Patient's Responsibilities for Self-Care After the Procedure
After the ULTRAcel Q+ HIFU Treatment, I am responsible for:
- Following post-procedure care instructions provided by the clinic.
- Monitoring my skin for any unusual reactions and reporting them to the clinic.
32. Further Interaction with the Clinic After the Procedure
The clinic will schedule follow-up appointments to assess my skin's response to the ULTRAcel Q+ HIFU Treatment and make any necessary adjustments to the treatment plan. I am encouraged to attend these appointments to ensure the best possible outcomes.
33. Possible Additional Procedures or Subsequent Treatment Phases
Depending on my skin's response to the ULTRAcel Q+ HIFU Treatment, additional sessions or alternative treatments may be recommended to further enhance the results.
34. Information on Clinic Rules and Policies Regarding Procedure Cancellation or Rescheduling
If I need to cancel or reschedule my ULTRAcel Q+ HIFU Treatment appointment, I agree to provide the clinic with at least [notice period] notice. Failure to do so may result in a cancellation fee.
35. Confirmation of Patient Understanding and Consent
I have read and understood the information provided in this consent form regarding ULTRAcel Q+ HIFU Treatment. I consent to undergo ULTRAcel Q+ HIFU Treatment at Elen Rivas Beauty Clinic and agree to the terms and conditions outlined above.
Patient's Signature: _______________________
Date: _______________________
Specialist's Signature: _______________________
Date: _______________________