RADIO FREQUENCY CONSENT
Please read carefully and initial:
I have not used retin-A for 72 hours
I do not have any active cold sores.
I acknowledge that there is a rare possibility of an allergic reaction. I have previously used alphahydroxy acid products on my skin and/or in the past with no allergic reaction, but understand there still could be a response.
I agree to avoid direct sun exposure for 48 hours.
I agree to notify my esthetician of any concerns.
I agree not to wax for 72 hours pre/post treatment.
There will be a $50 charge for patients who aren't shaved and need shaving. Your appointment may have to be rescheduled if you do not come shaved and our schedule does not allow enough time to perform your treatment.
We have a 24-hour cancellation policy. You will be changed full price for all appointments that are a no show and $25 for appointments that are cancelled in less than the 24 hour period. You must have a credit card on file at all times while receiving treatments at Blue Divine due to this cancellation policy. No refunds.
Radio Frequency Informed Consent
Radio Frequency is a non-invasive cosmetic procedure to help smooth, tighten, contour skin and temporarily reduce the appearance of cellulite. It can help treat sagging skin, lack of definition in the jaw line, loose jowls, sagging neck skin, wrinkles and fine lines.
Radio Frequency uses electical pulses to target and penetrate the underlayer of skin using heat to stimulate collagen. The outer layer of skin is cooled during the process to avoid damage. During procedure you will feel a brief deep heating sensation.
Results should be visible immediately and improve over a period of two to six months.
Treatment Sites include; Face, Area Surrounding Lip, Outer orbit area of the Eyes, Arms, Thighs, Tummy, Hands, Buttocks.
Side effects are rare but can include swelling, redness, bumps, minor burns and blisters on or around the treated area.
Alernative methods to Radio Frequency are Botox, Dermal Fillers, Laser and Surgery.
I understand and agree that all services rendered to me are charged directly to me and that I am personally responsible for payment. I further agree in the event of non-payment, to bear the cost of collection, and/or Court cost and reasonable legal fees, should this be required.
My questions regarding the procedure have been answered satisfactorily. I understand the procedure and accept the risks. I hereby release Blue Divine Aesthetics Staff, and specific technicians from liability associated with the procedure.