Accent XL Informed Consent

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I understand that the Accent XL is a radio-frequency device (RF) device intended for use in dermatologic and general surgical procedures for non-invasive treatment of wrinkles and rhytides. I understand that multiple treatments may be required and that there is no guarantee that the wrinkles/rhytides will be completely removed. I understand that there is a possibility of short term (few seconds to hours) adverse effects such as heating sensation, erythema and dry skin. Burns may occur in rare situations. These possible adverse effects have all been fully explained to me *

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I understand that the treatment by the Accent XL system involves a series of treatments and the fee structure has been fully explained to me. I also understand that there are other options for wrinkle and rhytides treatment that are available and each of these other options have fully been explained to me *

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With this in mind, I am choosing to try Accent XL non-invasive treatment for wrinkle and rhytides reduction. 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. *

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PHOTOGRAPHS : I do ____ do not ___ give permission for photographs and other audio-visual and graphic materials to be used by the physician or Alma Lasers, Inc for marketing, education-promotion purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I may or may not be identified by the photos. *

I have read and understand this agreement and all my questions have been addressed and answered to my satisfaction. I agree to the terms of this agreement. *

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