I duly authorize ______Flawless MedSpa______________ to use the Pixel Fractionated Skin Resurfacing System to perform fractional ablative skin resurfacing and any post treatment medical requirements that may be necessary.
I understand that the Pixel Fractionated Skin Resurfacing System is a laser device designed for fractional ablative skin resurfacing and that clinical result may vary in different skin types. I understand there is a possibility of short-term effects such as reddening, blistering, scabbing, temporary bruising and temporary discoloration of the skin, as well as rare side effects such as scarring and permanent discoloration . These effects have been fully explained to me
Clinical results may vary depending on individual factors, including medical history, amount of sun damage or textural problems, skin type, patient compliance with pre/post treatment instructions, and individual response to treatment.
I understand that treatment by the Pixel Fractionated Skin Resurfacing System involves a series of treatments and the fee structure has been fully explained to me
I certify that I have been fully informed of the nature and purpose of the procedure, expected outcomes and possible complications, and I understand that no guarantee can be given as to the final result obtained. I am fully aware that my condition is of cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so.
I confirm that I am not pregnant at this time, and that I have not taken Accutane within the last 6 months. I do not have a pacemaker or internal defibrillator. I also have completed a medical history checklist and been informed about what I must do and “not do” before, during and after the series of treatments.
I consent to the taking of photographs and authorize their anonymous use for the purposes of medical audit, education and promotion.
I understand that Flawless Medspa has a 24-hour cancellation policy. Should you need to cancel or reschedule an appointment please give us 24-hour notice so we can make the time available to other clients. Failure to show up for a scheduled appointment will result in forfeiture of prepaid services booked. No refunds are made for products, service packages and prepaid treatments once they are purchased.
I certify that I have been given the opportunity to ask questions and that I have read and fully understand the contents of this consent form.
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