What service are you receiving today? *
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Gender at birth *
Have you recieved the SELECTED MED-SPA services at our stores? *
Do you have any of the following in your body? If you have any of these metals please inform your service provider. *
Do you have any changes to your medical history since your last visit? *
Do you have or have you ever had any of the following conditions: *
Pertinent medical/surgical history: *
Birth control method: *
Please initial if you are postmenopausal, have a uterus, and are getting estradiol. *
Surgical History *
Medication History *
Are you currently using or do you have a history of tobacco use? *
Are you currently using or do you have a history of illegal drug use? *
Please describe your alcohol consumption : *
Have you had any of these services in the past 2 weeks? *
PATIENT CONSENT FOR PHYSICIAN TO USE OR DISCLOSE HEALTH CARE INFORMATION FOR TREATMENT, PAYMENT, AND HEALTH CARE. *
I have recieved the HIPPA information *
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CONSENT FOR TEXT MESSAGING OF HEALTH INFORMATION 1. CONSENT TO RECEIVE TEXT MESSAGES By providing your mobile phone number and opting into text messaging services, you consent to receive health-related information, including but not limited to appointment reminders, treatment updates, and other relevant communications directly to your mobile phone via text message. 2. NATURE OF COMMUNICATIONS Text messages may contain sensitive health information, including details related to your medical care, appointment schedules, and other pertinent information regarding your treatment or health status. 3. CONFIDENTIALITY AND SECURITY While every effort will be made to ensure the confidentiality and security of your information, text messaging is not a fully secure method of communication. B. Sweet will use reasonable measures to protect the privacy of the information transmitted but cannot guarantee that text messages will be free from unauthorized access. 4. WITHDRAWAL OF CONSENT You may withdraw your consent to receive text messages at any time by notifying B. Sweet in writing or by contacting our office directly. Withdrawal of consent may result in the discontinuation of text messaging services. 5. ACKNOWLEDGEMENT AND ACCEPTANCE By providing your mobile phone number and agreeing to receive text messages, you acknowledge that you understand the nature of the communications you will receive, the potential risks involved, and the terms under which your health information may be sent to you via text message. 6. LIABILITY B. Sweet, its affiliates, employees, and agents shall not be liable for any unauthorized access to or interception of text messages, or for any damages arising from the use of text messaging services, including but not limited to, any loss or misinterpretation of health information. By continuing with the provision of your mobile phone number and agreeing to receive text messages, you confirm that you have read, understood, and accepted the terms and conditions outlined in this consent form. ACKNOWLEDGEMENT AND CONSENT REGARDING THE USE AND DISCLOSURE OF HEALTH INFORMATION 1. ACKNOWLEDGEMENT OF PRIVACY AND CONFIDENTIALITY I acknowledge that my health information is private and confidential. I understand that B. Sweet is committed to safeguarding my privacy and preserving the confidentiality of my personal health information. 2. CONSENT TO USE AND DISCLOSE HEALTH INFORMATION By signing this document, I consent to B. Sweet's use and disclosure of my personal health information for the purposes of providing health care services to me, handling billing and payment, and conducting other health care operations. I understand that my failure to sign this consent form may result in B. Sweet declining to provide treatment. 3. REQUEST FOR RESTRICTIONS Under the terms of this consent, I have the right to request B. Sweet to impose restrictions on how my personal health information is used or disclosed for treatment, payment, or health care operations. I acknowledge that B. Sweet is not obligated to agree to such restrictions. If B. Sweet does agree to my request, I understand that they will adhere to the agreed-upon limits. 4. RIGHT TO REVOKE CONSENT I understand that I have the right to revoke this consent in writing at any time. Should I choose to cancel this consent, I recognize that B. Sweet may have already used or disclosed my information, and revoking consent will not affect information that has already been used or disclosed. To cancel this consent, I must provide a written, signed, and dated letter to [Insert Provider Name Here] indicating my desire to revoke authorization for the use and disclosure of my personal health information for treatment, payment, and health care operations. 5. IMPACT OF CANCELLATION I understand that if I cancel this consent, B. Sweet is not obligated to provide further health care services to me. By signing this document, I confirm that I have read, understood, and agreed to the terms and conditions outlined herein. *
TO GIVE CONSENT TO DISCLOSE HEALTH CARE INFORMATION TO SOMEONE OTHER THAN THE PATIENT, PLEASE WRITE THEIR NAME BELOW: (E.G. FAMILY MEMBER, CARETAKER)
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TEETH WHITENING 

Teeth whitening involves the application of a bleaching agent 16% HP to the teeth to remove stains and discoloration.

Benefits:
1. Whiter and brighter teeth
2. Enhanced appearance and self-confidence

Possible Risks and Side Effects:
1. Tooth sensitivity
2. Gum irritation
3. Uneven whitening results ( spotting ) usually temporary
4. Temporary or mild discomfort during or after the procedure
5. Allergic reaction (rare)

Pre-Treatment Instructions:
1. If you have any dental issues (e.g., cavities, gum disease, etc.), you must consult with a dentist before      undergoing the whitening procedure.
2. Avoid eating or drinking food or beverages that can stain your teeth (e.g., coffee, tea, red wine) prior to      your appointment.
3. If you have a history of sensitive teeth or allergies, please inform your practitioner.

Post-Treatment Instructions:
1. Avoid eating or drinking highly pigmented food or beverages (e.g., coffee, tea, red wine) for 24-48            hours after the procedure.
2. Maintain good oral hygiene practices, including brushing and flossing regularly.
3. If you experience discomfort or sensitivity, inform your practitioner.

I Acknowledge and Understand the Following:
I have been informed about the teeth whitening procedure, including its risks, benefits, and possible side effects. I understand that results may vary, and the procedure may not produce the same whitening outcome for everyone. I understand that teeth whitening does not work on all types of discoloration, and I may require follow-up treatments. I consent to the use of teeth whitening products as described by the practitioner. I will inform the practitioner of any allergies, dental conditions, or medical issues that may affect the procedure. Consent: By signing below, I give my consent for the teeth whitening procedure. I acknowledge that I have been fully informed about the treatment and its risks and have had all my questions answered to my satisfaction. I understand it may take several treatments to achieve desired whitening results.  *
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TEXAS PIERCING LAW

Any business in the practice of creating an opening in a person's body, other than the earlobe, to insert jewelry or another decoration needs to be to licensed with the Department of State Health Services. Our piercing licence number is 1001705.

An artist may not perform body piercing on a person younger than 18 without the consent of a parent, managing conservator, or guardian and meeting the requirements of 25 Texas Administrative Code, §229.406(d).

This can be done by one of two methods:

The minor brings a notarized consent to the studio that contains the name, address and phone number of the minor and parent, managing conservator or guardian; the location of the body that may be pierced; and signatures of the minor and the parent, managing conservator or guardian.

The adult is present at the studio during the piercing and signs statements swearing they are the parent, managing conservator or guardian; the adult has the authority to consent to the procedure; the adult has provided valid government issued identification of the minor and of themselves to the studio; and the adult will remain at the studio while the procedure is performed. In this case, the adult must also present identification and evidence to the studio they are the parent, managing conservator or guardian.
What type of injections will you be recieving today *
NEUROTOXIN COSMETIC DENERVATION INJECTION (BOTOX / DYSPORT / JEVEAU) CONSENT

This form is designed to provide you with the information you need to make an informed decision about whether to have (BOTOX / DYSPORT / JEVEAU) (Botulinum Toxin) treatment. If you have any questions or do not understand the potential risks, please do not hesitate to ask us.

How does (BOTOX / DYSPORT / JEVEAU) work? When a small amount of purified (BOTOX / DYSPORT / JEVEAU) protein is injected into a muscle it causes weakness or paralysis of that muscle. This appears in 5-7 days and usually lasts 3-4 months, but can be shorter or longer. These injections have been used for more than a decade in children and adults to improve the problem of facial muscle spasms. BOTOX has also been useful to correct double vision due to muscle imbalance.
 
For your Safety, You must inform your clinician of any recent illness, use of antibiotics, blood thinners, neurological disorders, NSAIDS, or if you have been diagnosed with any of the following conditions:
• Myasthenia Gravis
• Eaton-Lambert Syndrome
• Amyotrophic Lateral Sclerosis
• Allergy or sensitivity to albumin
• Any disorder that might interfere with neuromuscular function
• Bell’s Palsy
• ALS or MS
Important Information and Informed Consent
• I am not pregnant or nursing, nor have any significant neurological diseases to have this treatment.
• I have requested that Beauty Bar Med Spa attempt to improve my facial expression lines with BOTOX/ DYSPORT. I understand that there are NO GUARANTEES as results vary from person to person and that a very small percentage of people produce antibodies that will not allow them to benefit from BOTOX/ DYSPORT treatments.
• I agree that this constitutes full disclosure and that it supersedes any previous verbal and written disclosures. My signature indicates that I am consenting to receive treatment, having read and understood the information presented above and have been given the opportunity to ask any questions that I might have about this procedure. I have been advised of the risks involved in such treatment and alternative treatments, including no treatment at all.
• I consent to be photographed before, during and after treatment. These photographs shall be the property of (Your Business Name These photographs may be shown for scientific reasons, and/or used in patient education (both in and out of the office). I agree to keep (Your Business Name informed of any change of address so that they can notify me of any late findings.

I understand that I release Beauty Bar Med Spa and its associates, including the Medical Director, Nurse Practitioners or Physician Assistants along with any technician or employee of (Your Business Name) employee involved in my treatment from any liability associated with complications from the BOTOX/DYSPORT procedure.
I certify that I have been given the opportunity to ask questions and that I have

Frown lines between the eyebrows are due to contraction of small muscles in this area. Injecting BOTOX/ DYSPORT into this area will paralyze or weaken these muscles causing temporary improvements or disappearance of frown lines. The FDA has approved BOTOX COSMETIC/ DYSPORT to be used to improve the appearance of the vertical lines between the brows. Although not FDA approved, BOTOX/ DYSPORT have also been used successfully for many years to treat many other areas of the face. Similarly, crow's feet and horizontal forehead lines can also be improved by the injection of BOTOX/ DYSPORT into these areas. Lines at present rest may or may not improve. Aging, heredity and sun damage account for other facial wrinkles and may be treated with other non-surgical cosmetic treatments or surgery.

RISKS AND POTENTIAL SIDE EFFECTS OF NEUROTOXIN (Botulinum Toxin Type A) INJECTIONS

What are the risks associated with treatment? Side effects and complications have been minimal. Occasionally, slight swelling, numbness and/or bruising may last several days after the injection. Some may experience a transient headache at injection site. Rarely, an adjacent muscle may be weaken and cause a temporary droop of the eyelids. Other side effects may include respiratory infection, flu syndrome and nausea. A long term safety review of patients using BOTOX which totaled 853 treatment sessions noted only 9 events of side effects which were minimal and transient. In very small numbers of individuals the injection did not work as satisfactorily or for as long as usual.

Every procedure involves a certain amount of risk, and it is important that you understand the risks involved. An individual’s choice to undergo this procedure is based on the comparison of the risk to potential benefit. Although the majority of clients do not experience the following complications, you should discuss each of them with your treating clinician to make sure you understand the risks, potential complications, and consequences of neurotoxin injections.
Bleeding - It is possible, though unusual, to have a bleeding episode from a neurotoxin injection. Bruising in soft tissues may occur. Should you develop post-injection bleeding, it may require emergency treatment or surgery. Do not take any aspirin or anti-inflammatory medications for seven days before neurotoxin injections, as this may contribute to a greater risk of a bleeding problem.
Infection - Infection is extremely rare after a neurotoxin injection. Should an infection occur, additional treatment including antibiotics may be necessary.
Damage to deeper structures - Deeper structures such as nerves, blood vessels, and the eyeball may be damaged during the course of injection. Injury to deeper structures may be temporary or permanent.
Corneal exposure problems - Some clients experience difficulties closing their eyelids after neurotoxin injections and problems may occur in the cornea due to dryness. Should this rare complication occur, additional treatments, protective eye drops, contact lenses, or surgery may be necessary.
Dry eye problems - Individuals who normally have dry eyes may be advised to use special caution in considering neurotoxin injections around the eyelid region.
Migration of Neurotoxin- Neurotoxins may migrate from its original injection site to other areas and produce temporary paralysis of other muscle groups or other unintended effects.
Drooping Eyelid (Ptosis) - Muscles that raise the eyelid may be affected by neurotoxins, should this material migrate from injection areas.
Double-Vision -Double-vision may be produced if the neurotoxin material migrates into the region of muscles that control movements of the eyeball.
Eyelid Ectropion - Abnormal looseness of the lower eyelid can occur following a neurotoxin injection.
Other Eye Disorders - Functional and irritative disorders of eye structures may rarely occur following neurotoxin injections.
 
Subsequent touch-up treatments aimed at achieving optimal aesthetic results following the initial injection shall be permitted only within a period not exceeding thirty (30) days from the date of the initial paid treatment. Any touch-up requested after the thirty (30) day period shall necessitate an additional payment.
Dermal Filler Consent
Treatment with Restylane, Juvederm, Perlane, Bio-Filler or Collagen can smooth out folds and wrinkles, add volume to the lips, and contour facial features that have lost their fullness due to aging, sun exposure, illness, etc. Facial rejuvenation can be carried out with minimal complications. These dermal fillers are injected into the skin with a very fine needle. The products produce a natural volume under the wrinkle, which is lifted up and smoothed out. The results can often be seen immediately. Treating wrinkles with these dermal fillers is fast and safe and leaves no scars or other traces on the face.

RISKS AND COMPLICATIONS
It has been explained to me that there are certain inherent and potential risks and side effects in any invasive procedure and in this specific instance such risks include but are not limited to:

1) Post treatment discomfort, swelling, redness, and bruising, discoloration
2) Post treatment infection associated with any transcutaneous injection
3) Allergic reaction
4) Reactivation of Herpes (cold sores)
5) Lumpiness, visible yellow or white patches in approximately 20% of cases
6) Granuloma formation
7) Localized Necrosis and/or sloughing, with scab and/or without scab if blood vessel occlusion occurs.

PHOTOGRAPHS
I authorize the taking of clinical photographs and their use for scientific purposes both in publications and presentations. I understand my identity will be protected.

PREGNANCY, ALLERGIES & DISEASE
I am not aware that I am pregnant. I am not trying to get pregnant. I am not Lactating (nursing). I do not have or have not had any major illnesses which would prohibit me from receiving any of the above mentioned dermal fillers. I certify that I do not have multiple allergies or high sensitivity to medications, including but not limited to Lidocaine.

If receiving Collagen I have read the brochure titled "Zyderm®/Zyplast® or Cosmoplast™/Cosmoderm™Collagen Explained" in its entirety and have discussed the risks and benefits of injectable collagen treatment with my physician and/or his/her representative and have had all my questions answered. I understand the information provided.

PAYMENT
I understand that this procedure is cosmetic and that payment is my responsibility.

RESULTS
I am aware that full correction is important and that follow-up touch ups/treatments will be needed to maintain the full effects. I am aware that the duration of treatment is dependent on many factors including but not limited to: age, sex, tissue condition, my general health and life style conditions, and sun exposure. The correction, depending on these factors may last 3-6 months and in some cases longer. I been instructed in and understand post treatment instructions and have been given a copy of them.
 
Subsequent touch-up treatments aimed at achieving optimal aesthetic results following the initial injection shall be permitted only within a period not exceeding thirty (30) days from the date of the initial paid treatment. Any touch-up requested after the thirty (30) day period shall necessitate an additional payment.

I hereby voluntarily consent to treatment. The procedure (s) has been explained to me. I have read the above and understand it. My questions have been answered satisfactorily. I accept the risks and complications of the procedure. I certify that if I have any changes occur in my medical history I will notify the office.


I have received and understand the informed consent underlining the RISKS AND POTENTIAL SIDE EFFECTS OF INJECTABLES INCLUDING NEUROTOXIN, FILLER, KYBELLA and I agree to the terms of service *

INFORMED CONSENT FOR KYBELLA® (DEOXYCHOLIC ACID) AESTHETIC INJECTABLE TREATMENT

INSTRUCTIONS - This is an informed-consent document that has been prepared to help inform you concerning using deoxycholic acid injection injections with Kybella®. The use of aesthetic injections with Kybella has its risks and alternative treatments.

INTRODUCTION - Kybella® is a cytolytic drug indicated for improvement in the appearance of moderate to severe convexity or fullness associated with submental (neck) fat in adults. The safe and effective use of Kybella® for the treatment of subcutaneous fat outside the submental region (neck) has not been established and is not recommended. Kybella® is injected into the fat under the chin (no more than 50 injections or 10mL under the skin). Kybella® injections will be given at least one month apart. Your healthcare provider will decide how many treatments and injections are needed. Any other cosmetic use is considered “off label.”

ALTERNATIVE TREATMENTS - There are alternative forms to Kybella® that are non-surgical and surgical. The non-surgical alternatives consist of topical neck products, weight loss, and neck homeopathic treatments. The surgical alternatives of Kybella® are a neck lift, neck liposuction, and several others. Risks and potential complications are associated with alternative forms of treatment.

RISKS - There are risks of using Kybella®. Every cosmetic procedure involves a certain amount of risk, and it is important that you understand the risks involved. An individual’s choice to undergo a cosmetic procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience complications, you should discuss each risk with your provider or affiliated medical personnel.

IRRITATIONS - Kybella® injections can cause tingling, swelling, itching, skin tightness, and headache. These side effects typically resolve without treatment and do not commonly result in patients discontinuing treatment.

NERVE INJURY - Although unlikely, Kybella® injections could cause nerve injury in the area of the jaw resulting in an uneven smile or facial muscle weakness. In the clinical trials these all resolved without treatment in an average of six weeks. Tell your provider if you develop signs of marginal mandibular nerve paresis (e.g., asymmetric smile, facial muscle weakness), difficulty swallowing, or if any existing symptom worsens.

SWALLOWING - Although unlikely, Kybella® injections can temporarily cause trouble with swallowing. Tell your provider if you have had a history of troubled swallowing before your treatment. If you experience any problems swallowing after your treatment notify your provider immediately.

SKIN ULCERATION - Although unlikely, Kybella® injections could cause superficial skin erosions.

ALOPECIA - Although unlikely, Kybella® injections could cause small patches of alopecia (hair loss) in the treatment area. The hair on a man’s beard can potentially experience patches of hair loss that may be permanent.

BLEEDING - It is possible to experience a bleeding episode during or after injections. Should postprocedure bleeding occur, it may require emergency treatment to drain accumulated blood (hematoma). Ask your provider before taking any aspirin or anti-inflammatory medications for ten days before your procedure, as this may contribute to a greater risk of bleeding.

BLINDNESS – Although extremely rare, aesthetic injectables can cause permeant blindness by blocking the blood supply to the eye. The highest risk areas are around the glabella (the skin between the eyebrows and above the nose), nasal region, nasolabial fold, and forehead. The most common

symptoms are immediate vision loss and pain. Central nervous system complications related to the blindness can occur.

INFECTION - Kybella® should not be injected if there is a preexisting infection in the treatment area. In the rare event an infection occurred after treatment, additional treatment including antibiotics or an additional procedure may be necessary.

BRUISING AND SWELLING- Kybella® injections commonly cause swelling, bruising, pain, numbness, redness, and areas of hardness in the treatment area. You may have bruising within a week or more of having any injectables, so time your treatments with your schedule accordingly. Although wound healing after an injectable procedure is expected, you will want to keep ice on the treated area until it subsides. You may be asked to take a medication to reduce or prevent bruising such as Arnica Montana. Contact your provider if bruising lasts longer than a week or anytime if you are concerned.

DAMAGE TO DEEPER STRUCTURES - Deeper structures such as nerves, blood vessels, and muscles may be damaged during treatment with aesthetic injectables. The potential for this to occur varies according to where the treatment is being performed. Injury to deeper structures may be temporary or permanent.

UNSATISFACTORY RESULT - There is the possibility of an unsatisfactory result from aesthetic injectables. Aesthetic injectables may result in unacceptable visible deformities, loss of function, wound disruption, skin death, and loss of sensation. The procedure may result in unacceptable visible deformities or asymmetry in the treatment area. You may be disappointed with the results of Kybella®. The effectiveness of Kybella® may eventually subside but is not know when or if ever that will occur at this time. It is possible that Kybella® cannot be removed or corrected once inside your neck or body.

ALLERGIC REACTIONS - In rare cases, local allergies to injectables, lidocaine, or topical preparations have been reported. Systemic reactions, which are more serious, may result. Allergic reactions may require additional treatment. Lidocaine, a pain reliever used in most dentist offices, is an ingredient in many injectables. Tell your provider if you have an allergy to lidocaine or other allergies.

MEDICATION REACTION - Tell your provider if you are on, or were recently on, any medications as they may interfere with the ability of the aesthetic injectables to function. Even use of antibiotics and Aspirin should be brought to your provider’s attention. It is not recommended that you undergo this treatment if you are on blood thinners for any reason including bleeding disorders.

HERPES SIMPLEX VIRUS - Tell your provider if you get cold sores, fever blisters, or have been diagnosed with the herpes simplex virus. For your comfort we will recommend that you call your physician before treatment so you can take preventive medication to avoid an outbreak. Aesthetic injectable fillers do no not cause outbreaks, but can trigger a non-active outbreak.

PREGNANCY - Women should not have aesthetic injectables if they are pregnant or may become pregnant, or are breast feeding. PREVIOUS

SURGERY – Tell your provider about all past or planned surgeries and treatments of the face, neck, or chin as these could affect the effectiveness and safety of Kybella®

ADDITIONAL TREATMENTS MAY BE NECESSARY - In some situations, it may not be possible to achieve optimal results with a single aesthetic injectable treatment. Multiple sessions may be necessary. Should complications occur, additional injectables or other treatments may be necessary. INFORMED

CONSENT FOR KYBELLA® (DEOXYCHOLIC ACID) AESTHETIC INJECTABLE TREATMENT 

Informed consent documents are used to communicate information about the proposed injectable treatment along with disclosure of risks and alternative forms of treatments. The informed consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients in most circumstances. This informed consent should not be considered all inclusive in defining other methods of care and risks encountered. Your provider or affiliated medical personnel may provide you with additional or different information, which is based on all the facts in your particular case and the state of medical knowledge. Standards of medical care are determined on the basis of all of the facts involved in an individual case and are subject to change as scientific knowledge and technology advance and as practice patterns evolve. Even though risks and complications occur infrequently, the risks cited are the ones that are particularly associated with Kybella®. Other complications and risks can occur but are even more uncommon. The practice of medicine and aesthetic injectables is not an exact science. Although good results are expected, there cannot be any guarantee or warranty expressed or implied on the results that may be obtained.

MICRONEEDLING
 
REJUVAPEN
MORPHUS8
SECREC

skin needling system allows for controlled induction of the skin’s self-repair mechanism by creating micro injuries in the skin to trigger new collagen synthesis, while not posing the risk of permanent scarring. The result is smoother, firmer and younger looking skin. Skin needling treatments are performed in a safe and precise manner with the sterile needlehead and are normally completed within 30-60 minutes, depending on the selected area.

Side Effects

After the procedure, the skin may be red and flushed in appearance, similar to moderate sunburn. In the treatment area, skin tightness and mild sensitivity may also be experienced. These side effects will diminish within a few hours following treatment and over the next 24 hours. After 3 days, there will be little evidence that the procedure has taken place.

Contraindications

Contraindications and precautions include: keloid or raised scarring; history of eczema, psoriasis, actinic (solar) keratosis, herpes simplex infections, diabetes, and other chronic conditions; presence of raised moles, warts or any raised lesions in the target area. Absolute contraindications include: scleroderma, collagen vascular diseases or cardiac abnormalities; rosacea or blood clotting problems; active bacterial or fungal infections; immuno-suppression; scars less than 6 months old; and facial fillers used in the past 2 - 4 weeks. Treatment is not recommended for patients who are pregnant or nursing.

Patient Consent

I understand that results will vary between individuals. I understand that although I may see a change after my first treatment, I may require a series of sessions to obtain my desired outcome. The concept of microneedlig is “micro-wounds” are created. This triggers your body's wound healing processes to heal your micro wounds immediately. However, the most dramatic results will not be visible until four to six weeks after treatment

The procedure and side effects have been explained to me, including alternative methods. I understand the advantages and disadvantages of this procedure.

I am advised: though good results are expected, the possibility and nature of complications cannot be accurately advised; therefore, there can be no guarantee as expressed or implied either to the success or other result of the treatment. I am aware that the treatment is not permanent and natural degradation will occur over time.

I agree that I have read (or that it has been read to me) and understand this consent form, and that I understand the infor-mation contained in it.

I have had the opportunity to ask any questions about the treatment, including risks or alternatives, and I acknowledge that all my questions about the procedure have been answered to my satisfaction.
 
 
MICRONEEDLING REJUVAPEN MORPHUS8 SECREC skin needling system allows for controlled induction of the skin’s self-repair mechanism by creating micro injuries in the skin to trigger new collagen synthesis, while not posing the risk of permanent scarring. The result is smoother, firmer and younger looking skin. Skin needling treatments are performed in a safe and precise manner with the sterile needlehead and are normally completed within 30-60 minutes, depending on the selected area. Side Effects After the procedure, the skin may be red and flushed in appearance, similar to moderate sunburn. In the treatment area, skin tightness and mild sensitivity may also be experienced. These side effects will diminish within a few hours following treatment and over the next 24 hours. After 3 days, there will be little evidence that the procedure has taken place. Contraindications Contraindications and precautions include: keloid or raised scarring; history of eczema, psoriasis, actinic (solar) keratosis, herpes simplex infections, diabetes, and other chronic conditions; presence of raised moles, warts or any raised lesions in the target area. Absolute contraindications include: scleroderma, collagen vascular diseases or cardiac abnormalities; rosacea or blood clotting problems; active bacterial or fungal infections; immuno-suppression; scars less than 6 months old; and facial fillers used in the past 2 - 4 weeks. Treatment is not recommended for patients who are pregnant or nursing. Patient Consent I understand that results will vary between individuals. I understand that although I may see a change after my first treatment, I may require a series of sessions to obtain my desired outcome. The concept of microneedlig is “micro-wounds” are created. This triggers your body's wound healing processes to heal your micro wounds immediately. However, the most dramatic results will not be visible until four to six weeks after treatment The procedure and side effects have been explained to me, including alternative methods. I understand the advantages and disadvantages of this procedure. I am advised: though good results are expected, the possibility and nature of complications cannot be accurately advised; therefore, there can be no guarantee as expressed or implied either to the success or other result of the treatment. I am aware that the treatment is not permanent and natural degradation will occur over time. I agree that I have read (or that it has been read to me) and understand this consent form, and that I understand the infor-mation contained in it. I have had the opportunity to ask any questions about the treatment, including risks or alternatives, and I acknowledge that all my questions about the procedure have been answered to my satisfaction. *
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Do you have any of the following Contraindications Contraindications and precautions include: keloid or raised scarring; history of eczema, psoriasis, actinic (solar) keratosis, herpes simplex infections, diabetes, and other chronic conditions; presence of raised moles, warts or any raised lesions in the target area. Absolute contraindications include: scleroderma, collagen vascular diseases or cardiac abnormalities; rosacea or blood clotting problems; active bacterial or fungal infections; immuno-suppression; scars less than 6 months old; and facial fillers used in the past 2 - 4 weeks. Treatment is not recommended for patients who are pregnant or nursing. *
Do you have ANY of these conditions? *

Is the individual being pierced under 18 years old? *

Location of piercing *
INFECTION RISK: Any piercing can cause an infection. Cartilage piercings, which take place on the harder part of your ear, generally take longer to heal and can be more prone to infection. There are several ways your ear piercing can get infected. Any bacteria left to fester can quickly turn into an infection. If you touch your piercing with dirty hands or instruments, you can introduce an infection.The most commonly identified organisms from body piercing infections include skin flora responsible for skin and soft tissue infections such as staphylococcus and streptococcus species though there are a few exceptions. There is a higher rate of incidence of pseudomonas infections when involving the cartilaginous ear and nasal structures. We are not responsible for any infection, swelling, unsatisfactory healing, or allergic reaction caused by your choice to make an appointment and get a piercing at our studio. You may have some blood, swelling, tenderness, or bruising at first. It may be sore, tender, and red for up to 3 weeks. Pierced nostrils heal completely in about 2 to 4 months. *
No Refunds will be given after the payment is recieved regardless of healing, lost earring, etc. *
DISCLAIMER OF RISKS AND LIABILITIES REGARDING EYELASH EXTENSIONS, LASH REMOVAL, AND LASH LIFTS Expect up to 7ish lashes to fall out per day. If you experience unusal fallout (More than half your lashes within 3 days) we will provide a FREE 60 minute fix within 9 days of your original appointment if you contact us within 3-4 days, Or choose a extra 60 minutes of lashing time free to your next scheduled 1 hour appointment making the appointment 2 hours to ensure you get back to a full status. Current unusal fallout rate at at our stores in 2023 is 0.4% or 4 per 1000 applications The application of eyelash extensions, lash removal, and lash lifts may result in irritation, burning sensations, or allergic reactions. It is standard for symptoms of such reactions to manifest progressively within 24 to 72 hours post-application. Approximately 3-5% of the human population may be, or may become, allergic to eyelash adhesive. Allergic reactions to eyelash glue may develop after multiple exposures. Eyelash extensions and lash lifts carry inherent risks of eye damage and eye irritation. While all staff are trained professionals, these services are not without risk. By consenting to these services, you acknowledge and accept the associated risks and agree that B. Sweet shall not be liable for any medical expenses incurred. IRRITATION Irritation may present as discomfort in the eye area, including mild itchiness, tearing, or a slight burning sensation. ALLERGIC REACTION An allergic reaction to eyelash glue may involve swelling, noticeable redness, itchiness, and watery eyes. Unlike irritation, which typically occurs immediately, allergic reactions may develop several hours after exposure. Professional adhesive removers are the safest and least damaging method for removing eyelash extensions. However, adhesive removers may cause stinging and additional irritation. For removal of extensions, we recommend scheduling a Lash Removal service, which utilizes specialized lash glue solvents that may cause burning and stinging in the eye area. In the event of an allergic reaction or eye irritation, we will provide a complimentary lash removal and refund. Refunds for eyelash extension services will not be issued unless a removal is performed within 4 days of the initial application. By signing, you are consenting to the terms of service. *
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Current Skin Concern *
Have you received any of these services in the past 7 days? *
Do you have or have you had any of the following medical conditions that could compromise your skin & or services being offered? Use of Accutane, Adapalen, Isotetinoin, Retin-a, Renova, Alustra, Avita, Tazarotene, Tretinoin, Avage, Differin Sunburned skin, Retinol, Certain medical conditions, Pregnency, Antibiotics, Frequent Tanning or Other medications not listed. These things can make your skin thinner and more sensitive *
I understand that if I begin use or are curently using any of the products listed in the above warning and do not inform the esthetician prior to current or future treatment, I accept full responsibility for any adverse reactions. I understrand that the techncian is fully trained but waxing does include risks and may cause some redness, bumps, skin lift, soreness, and/ or itching regardless of precausions. *
I understand that BRAZILIAN & BIKINI waxing may result in leftover wax or oils in hard to reach areas. I concent to the technician viewing and touching the intimate areas. *

Brief Information

Laser hair removal involves the use of a non-invasive laser device for the reduction of facial or body hair. This works on the hairs that are in the active stage of growth and thus, it does not work on dormant hairs. The procedure for this requires more than one session. Please take note as well that the hair removal session may vary per individual depending on the amount of hair, density, or color.

We recommend around 6-15 sessions. Laser hair removal is not completely permanent and revisits may be needed for maintenance.

Preparatory Care Procedures

Prior to undergoing treatment, one must avoid over-exposure to sunlight or using tanning treatments. Prepare this at least a month prior to the treatment date.

It is likewise necessary to have the area to be treated shaved a day or two prior the appointment date. If the area is not shaved we may shave the area with an additional fee.

Please do not wax, tweeze, or use hair-removing creams that can affect in greatly decreasing the efficacy of laser hair removal treatments.

It is recommended to check with us if the patient is taking any medications. There are those that can affect the skin's photosensitivity and therefore can be dangerous when undergoing any laser treatment.

 

Potential Risks and Expectations

The following are possible risks that patients may experience with the hair removal treatment:

Minor wounds. Laser hair removal treatment can result in blistering, mild skin burn, flaking of the skin, or sometimes swelling on the surface of the treated skin areas. This is common especially in bikini and other areas where skin is very thin. In such cases, it is recommended that the area should heal first prior to undergoing another treatment.

Discomfort. Patients may experience discomfort during the treatment. Please take note that this is a normal occurrence. 

Pigment changes. There is the possibility that there might be a darkening or lightening of the color of the skin during the healing process. This is usually temporary but on rare occasions, it can be permanent.

Eye exposure. Exposure to the eye with lasers can lead to temporary or permanent eye damage. However, please take note that we will provide eye protection during the treatment period. Please keep the protection on during the treatment and do not remove it unless allowed by us.

Scar. Scarring might occur in rare instances, especially if the prior or post procedures are not complied with. Thus, it is important that the pre and post-procedural treatment guidelines are carefully followed.

Post Care Instructions

Avoid scratching, touching, or picking on your skin's treated area as this may get irritated or infected. Avoid any tanning lotion or being exposed under the sun for long periods within the first 3 days after treatment. This may cause hyper pigmentation on the treated area.

If skin does not look suitable for treatment despite answers to the contradiction list, the technician may refuse and rebook to ensure health and safety. No refunds will be given due to minor burns, blisters or other common risks of LHR.

PELLET INSERTION CONSENT FOR FEMALES

 
My physician/practitioner has recommended bioidentical hormone
therapy delivered by a pellet inserted under my skin for treatment of
symptoms I am experiencing related to low hormone levels.
The following information has been explained to me prior to receiving
the recommended therapy.
OVERVIEW
Bioidentical hormones are hormones that are biologically identical
to that made in my own body. The levels of active estradiol and/or
testosterone made by my body have decreased, and therapy using
these hormones may have the same or similar effect(s) on my body
as my own naturally produced hormones. The pellets are a delivery
mechanism for estradiol and/or testosterone, and bioidentical hormone
replacement therapy using pellets has been used since the 1930’s.
There are other formulations of estradiol and testosterone replacement
available, and different methods can be used to deliver the therapy.
There are no commercially available forms of testosterone, however,
that are formulated specifically for use in women. The risks associated
with pellet therapy are generally similar to other forms of replacement
therapy using bioidentical hormones.
 
RISKS/COMPLICATIONS OF TESTOSTERONE
Risks associated with pellet insertion may include: bleeding from
incision site, bruising, fever, infection, pain, swelling, pellet extrusion
which may occur several weeks or months after insertion, reaction
to local anesthetic and/or preservatives, allergy to adhesives from
bandage(s), steri strips or other adhesive agents.
Some individuals may experience one or more of the following
complications with testosterone: acne, abnormal bleeding or a change
in menstrual cycle (if patient has a uterus), anxiety, breast or nipple
tenderness or swelling, insomnia, depression, mood swings, fluid
and electrolyte disturbances, headaches, increase in body hair, fluid
retention or swelling, mood swings or irritability, rash, redness, itching,
lack of effect (typically from lack of absorption), transient increase in
cholesterol, nausea, retention of sodium, chloride and/or potassium,
weight gain or weight loss, thinning hair or female pattern baldness,
hypersexuality (overactive libido) or decreased libido, overproduction
of estrogen (called aromatization) or an increase in red blood cell
formation or blood count (erythrocytosis). The latter can be diagnosed
with a blood test called a complete blood count (CBC). This test should
be done at least annually. Erythrocytosis can be reversed simply by
donating blood periodically, but further workup or referral may be
required if a more worrisome condition is suspected.
If you are planning to start or expand your family soon, please talk
to your provider about other options.
 
RISKS/COMPLICATIONS OF ESTRADIOL (ONLY
APPLICABLE IF RECEIVING ESTRADIOL IN THE PELLETS)
The side-effects of estradiol are similar to those listed above for
testosterone. Additionally, there is some risk, even when using
bioidentical hormones, that estrogens may cause existing cases of some
breast cancers to grow more rapidly. This risk may also apply to some
undiagnosed forms of breast cancer.
Using estrogen-alone (without progesterone) may increase the chance
of getting cancer of the uterus. Endometrial sampling (biopsy) or
surgery may be required if abnormal bleeding occurs.
 
RISKS/COMPLICATIONS OF ANASTROZOLE
(ONLY APPLICABLE IF RECEIVING ANASTROZOLE
IN THE PELLETS)
Anastrozole is a type of medication called an aromatase inhibitor.
Aromatase inhibitors limit or prevent the conversion of testosterone into
estrogen. Aromatase inhibitors can be used for a variety of conditions
but are most commonly used in patients with a history of estrogen
receptor positive breast cancer.
Anastrozole should not be used in pregnant women and should be
used with caution in women with pre-existing ischemic heart disease.
Anastrozole in pellets should not be given to premenopausal women nor
to women taking oral aromatase inhibitors (anastrozole or letrozole) or
selective estrogen receptor modulators (tamoxifen or raloxifene).
The amount of anastrozole used in pellets is very low. The most common
side-effects for women taking anastrozole are hot flashes, joint pain, and
muscle pain. Because of the low dose in the pellet, these effects are not
usually seen with this type of therapy, however.
 
CONSENT FOR TREATMENT:
I agree to immediately report any adverse reactions or problems that
may be related to my therapy to my physician or health care provider’s
office, so that it may be reported to the manufacturer. Potential
complications have been explained to me, and I acknowledge that I have
received and understand this information, including the possible risks
and potential complications and the potential benefits.
I also acknowledge that the nature of bioidentical therapy and other
treatments have been explained to me, and I have had all my questions
answered. I understand that follow-up blood testing will be necessary
four (4) weeks after my initial pellet insertion and then at least one time
annually thereafter. I also understand that although most patients will
receive the correct dosage with the first insertion, some may require
dose changes.
I understand that my blood tests may reveal that my levels are not
optimal which would mean I may need a higher or lower dose in the
future. Furthermore, I have not been promised or guaranteed any
specific benefits from the insertion of testosterone pellets.
I accept these risks and benefits, and I consent to the insertion of
testosterone pellets under my skin performed by my provider. This
consent is ongoing for this and all future insertions in this facility until I
am no longer a patient here, but I do understand that I can revoke my
consent at any time. I have been informed that I may experience any of
the complications to this procedure as described above.
I have read or have had this form read to me.
 
PELLET ACTIVE INGREDIENTS COULD INCLUDE:

pellets that contain testosterone only.
pellets that contain estradiol and testosterone.
pellets that contain testosterone and anastrozole.
 
 
Laser hair removal treatment can cause problems for those with active or chronic herpes simplex viral infections. Your practitioner must know before treatment if you suffer from such an infection. You can be given antiviral medication several days before starting treatment and this will normally continue for up to 1 week. Antiviral medication is particularly important if you suffer from viral lesions on the area you want to have treated. *
Care should also be taken if you suffer from hypertrophic scarring or keliod formation. Your practitioner should use their own judgement and advise you as you may have problems with skin healing if the skin is damaged during laser treatment. *
Do you have a Tattoo in the area being lasered? BB glow? *
Other conditions which should be approached with caution include psoriasis, bleeding disorders, vitiligo and severe histamine reactions. *
Laser hair removal treatment should not be carried out on skin which is sunburnt, tanned, spray tanned or had surgeries such as laser resurfacing and chemical peels because the laser will possibly burn you. *
Have you has LHR at a different facility - What was the result? Did you have any burns or adverse reactions? *
If you are currently taking isotretinoin (or Accutane as it is commercially known), you should havevstopped taking this 6 months before undergoing laser hair removal treatment. This drug can cause skin sensitivity and this is not beneficial in laser hair removal treatment. *
Are you pregnant or breastfeeding? *
Have you recently tweezed or waxed the area? If so, the laser will not identify the hair follicle and the LHR session will be ineffective. *
Photosensitising drugs and antibiotics can make your skin ULTRA sensitive and possibly can cause a burn during LHR There are a multitude of common drugs, which can also interfere with treatment. Steroids, antibiotics such as tetracyclines and analgesics like ibuprofen are just some such drugs. Why do antibiotics increase photosensitivity? On a structural level, the molecules in these medications can destabilize. If destabilization occurs, chemicals build up in the skin, resulting in increased sun sensitivity and other problems Common Sun-Sensitizing Drugs Antibiotics: doxycycline, tetracycline, ciprofloxacin, levofloxacin, ofloxacin, trimethoprim Antidepressants: doxepin (Sinequan); and other tricyclics; St. John's wort Antifungals: griseofulvin Antihistamine: promethazine, diphenhydramine Antihypertensives (blood pressure drugs): hydrochlorothiazide (also found in some blood pressure medicines: Aldactazide, Capozide), diltiazem (Cardizem) Benzocaine Benzoyl peroxide Cholesterol drugs: atorvastatin, lovastatin, pravastatin, simvastatin Chemotherapy drugs: doxorubicin, flutamide, 5-FU, gemcitabine, methotrexate Diuretics: bumetanide, furosemide, hydrochlorothiazide Hypoglycemics: glipizide, glyburide Neuroleptic drugs: Chlorpromazine, fluphenazine, perphenazine, thioridazine, thiothixene Nonsteroidal anti-inflammatories: celecoxib, ibuprofen, ketoprofen, naproxen, piroxicam Other drugs: dapsone, Para-aminobenzoic acid (PABA), quinidine. PDT Pro photosensitizers: 5-aminolevulinic acid, methyl-5-aminolevulinic acid Retinoids: acitretin, isotretinoin Sulfonamides: sulfadiazine, sulfamethoxazole, sulfasalazine, sulfisoxazole Please list current medications Tetracycline, doxycycline, nalidixic acid, voriconazole, amiodarone, hydrochlorothiazide, naproxen, piroxicam, chlorpromazine and thioridazine *
Laser hair removal is now required to be called Laser hair REDUCTION. Although laser hair removal effectively delays hair growth for long periods, it usually doesn't result in permanent hair removal. Multiple laser hair removal treatments are needed for initial hair removal, and maintenance treatments might be needed in the future. I understand I need multiple LHR treatments 6-15 to achieve significant hair reduction *
Tattoos Laser hair removal treatments can alter the appearance of tattoos. If you have a tattoo on the area you want to have treated you should consider your decision carefully. The laser can cause changes in the pigments of the ink used in tattoos and this will change the way it looks. The pigments can be lightened or darkened by the laser. Not all pigments will react with the laser though; so changes may not occur, but there is a risk. *
Risks of side effects vary with skin type, hair color, treatment plan and adherence to pre-treatment and post-treatment care. The most common side effects of laser hair removal include: Skin irritation. Temporary discomfort, redness and swelling are possible after laser hair removal. Any signs and symptoms typically disappear within several hours. Pigment changes. Laser hair removal might darken or lighten the affected skin. These changes might be temporary or permanent. Skin lightening primarily affects those who don't avoid sun exposure before or after treatment and those who have darker skin. Laser hair removal can cause blistering, Superficial burn, crusting, scarring or other changes in skin texture. Other rare side effects include graying of treated hair or excessive hair growth around treated areas, particularly on darker skin. Laser hair removal isn't recommended for eyelids, eyebrows or surrounding areas, due to the possibility of severe eye injury. I understand the technician performing the service is fully trained and will set the LHR machine at the level they see fit for your fitzpatrick level. Dispite these percausions risks are involved. I have read and understand the risks. *
I hereby authorize the clinic to perform laser hair removal on me. I understand the risks involved in the procedure and I understand that I may need to undergo several treatments in order to obtain my desired results. I understand the pre and post-treatment procedures needed for me to comply with upon undergoing the laser hair removal treatment. I have asked questions which are unclear to me and I have received explanation about them to my satisfaction. I declare that I am of legal age and can exercise this consent with full discretion and responsibility to being legally bound under the terms and conditions of the treatment. *
You have answered YES to some questions that indicate this service requires some additional screening. Please see reception. We will discuss it with our Nurse Practioner and find the best option for you.
You have answered YES to some questions that indicate a facial within 30 days of the previous service may cause damage or irritation - Please see reception for further evaluation by the technician.
Sensitivity ALERT - You have answered YES to some questions that indicate your technician needs to take extra care. Please inform your technician of your answers.
Sensitivity ALERT - You have answered YES to some questions that indicate your technician needs to take extra care. Please inform your technician of your answers.
Allergy Alert - You have answered YES to some questions that indicate your technician needs to take extra care. Please inform your technician of your answers.
Allergy Alert - You have answered YES to some questions that indicate your technician needs to take extra care. Please inform your technician of your answers.
EYELASH EXTENSIONS - You have answered YES to some questions that indicate your technician needs to take extra care. Please inform your technician of your answers.
LASH LIFTS & TINTS - You have answered YES to some questions that indicate your technician needs to take extra care. Please inform your technician of your answers.
FACIAL SKIN SENSITIVITY ALERT - You have answered YES to questions that indicate your technician needs to take extra care. Please inform your technician of your allergies or skin conditions.
FACIAL SKIN ALERT - You have answered YES to questions that indicate your technician needs to take extra care. Please inform your technician of any medical conditions, topical creams, antibiotics, sunburn pregnancy etc.

Ultrasound Pre-care Instructions REVIEW (sent in booking e-mail)

  • Avoid Aspirin/ibuprofen or any vitamins that my thin the blood 72hr before treatment

  • Detox 24hr Prior to treatment (for lasting results, detox twice a week)

  • Avoid eating 2 hrs. prior and 2 hrs. after treatment (4 Hours of no eating)

  • Must eat after 4 hrs. or body will go into starvation mode and reject treatment.

  • Drink plenty of water to facilitate the lymphatic system (2-3 bottles before & after treatment. Growing water intake up to a gallon per day.)

  • Limit Carbonated drinks, coffees, and any teas that are not for the purpose of detoxing

  • Refrain from all breads, rice, pastas, sodas, cookies, candies and any other unhealthy foods during the duration of receiving treatments.

Ultrasound Cavitation Post-Care Instructions:

  • Drink at least 1 liter of water immediately following the appointment and throughout the week. This flushes out the toxins. Do a minimum of 20 minutes of elevated heart rate cardio exercise. This is best to be done immediately after the treatment, and for three days following. This is to ensure the stored energy released by the cavitation process is burnt off. If cardio is not your style, infrared sauna sessions may assist, as it has a similar effect on the body.

  • Overall maintaining a low calorie, low carbohydrate, low fat, and low sugar diet for 24 hours pre-treatment and three days post-treatment will help achieve the best results. This is to ensure your body utilizes triglycerides (a type of body fat) released by the cavitation process. We also encourage clients to stick to this diet as much as they can. Many find this to be a great starting point for maintaining a healthier lifestyle in the future.

  • Additional steps can be taken to achieve optimum results such as topically stimulating the treatment area following your session or using a body brush in the shower to promote movement around the area. Using moisturizer daily, and liberally massaging moisturizer on the treatment area is also beneficial. Do this daily to prevent fat and toxins from becoming stagnant and difficult to eliminate.

Ultrasound Cavitation FAQ’S

Q: How often should you get this treatment?

A: 1-2x a week. Your body will need 2-3 days to process all toxins released into your system.

Q: How many treatments will I need?

A: Everybody is unique and has different needs and goals. A consultation and discussion of your body goals should be performed in order to assess body goals. It is usually recommended 6- 12 sessions in conjunction with a total body goal plan.

Q: How long do results last?

A: Results are permanent however due to a variance of your physical lifestyle and dietary habits it is recommended for best results to schedule maintenance appointments as recommended or as needed.

 
A:about 6 to 12 weeks
 
It takes about 6 to 12 weeks to see the results of ultrasonic cavitation. Which body parts are best for ultrasonic cavitation? Ultrasonic cavitation works best on parts with localized fat. Such areas include the abdomen, flanks, thighs, hips, and upper arms
I agree to inform the technician of any skin conditions or allergies prior to my service. Many of our treatments involve the application of gels, creams, adhesives, or other chemical products. It is important to disclose this information in writing and also communicate it directly to your technician. For lash services, in particular, any allergies or sensitivities could impact lash retention or cause an allergic reaction or skin irritation. *
Ultrasonic Cavitation is not for people with heart disease, kidney failure, or liver failure. It is not for those who are pregnant, and you must wait a minimum of three months after childbirth, or at least six months after C section. individuals with acute or contagious disease, HIV, a history of cancer, kidney failure, liver failure, fatty liver, implant devices such as pacemakers or electrical prosthesis, epilepsy or MS *
BODY CAVITATION ALERT! You have answered YES to some questions that indicate this service requires some additional screening. Please see reception. We will discuss it with our Nurse Practioner and find the best option for you.
There are very few risks associated with this procedure, but that doesn't mean that there are no side effects. Bruising and pain are common short-term side effects, and some people have loose skin or dimples and waves in their skin after healing from this treatment *
For Best Results - Prior to having Ultrasound Cavitation you should follow a low fat/low carb diet and drink at least 2 liters of water 24 hours before your treatment. For 3 days following your treatment, you should continue to drink 2-3 liters of water a day. *
Cavitation is generally considered to produce permanent results, as the treatment breaks down fatty deposits in your body. However, the treatment doesn't prevent your body from creating new fat cells – and it is not seen as a weight loss solution *

EM MUSCLE STIMULATION TERMS OF SERVICE

LHR TERMS OF SERVICE

DISCLAIMER OF RISKS AND LIMITATIONS REGARDING LASER HAIR REMOVAL Laser hair removal procedures involve the application of laser technology to target hair follicles, with the intention of reducing or permanently removing unwanted hair. By undergoing this procedure, you acknowledge and accept the following: RISKS AND SIDE EFFECTS Skin Irritation and Sensitivity: The laser hair removal process may cause temporary skin irritation, including but not limited to redness, swelling, and discomfort in the treated area. These symptoms are typically transient but may persist for an extended period in some cases. Pigmentation Changes: There is a risk of changes in skin pigmentation, including hyperpigmentation or hypopigmentation, in the treated area. Such changes may be temporary or permanent and vary depending on individual skin type and response. Pain and Discomfort: The procedure may cause a sensation of discomfort or pain, which can vary from mild to moderate, depending on the individual’s pain threshold and the area being treated. Allergic Reactions: Although rare, some individuals may experience allergic reactions to the laser or cooling agents used during the procedure. Symptoms may include itching, rash, or swelling. Scarring: While rare, there is a potential risk of scarring or skin damage as a result of the procedure. This risk is influenced by factors such as individual skin type, pre-existing conditions, and adherence to post-treatment care instructions. Infection: Although uncommon, there is a potential risk of infection in the treated area. Proper aftercare is essential to minimize this risk. CONTRAINDICATIONS Laser hair removal may not be suitable for individuals with certain medical conditions, skin types, or those who are pregnant. It is essential to disclose all relevant medical history and conditions to the practitioner prior to the procedure. CONSENT AND ACCEPTANCE By consenting to laser hair removal services, you acknowledge that you have been informed of the potential risks, side effects, and limitations associated with the procedure. You agree to follow all pre- and post-procedure care instructions provided by the practitioner. You further agree to release and hold harmless [Practitioner/Business Name] and its affiliates, employees, and agents from any and all liability for any adverse effects, complications, or outcomes resulting from the procedure. REFUNDS AND COMPLAINTS Refunds for laser hair removal services will not be provided once the procedure has commenced. Complaints or concerns regarding the procedure must be submitted in writing within 7 days of the treatment date for review and resolution. By proceeding with laser hair removal services, you confirm that you have read, understood, and accepted the terms and conditions outlined herein. *
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DISCLAIMER OF RISKS AND LIMITATIONS REGARDING EM CONTOUR TREATMENTS 1. NATURE OF TREATMENT Electromagnetic contouring (EM Contour) treatments involve the use of electromagnetic technology to target and stimulate muscles and tissues in order to achieve cosmetic improvements, such as enhanced muscle tone and body contouring. 2. RISKS AND SIDE EFFECTS By undergoing EM Contour treatments, you acknowledge the following potential risks and side effects: a. Discomfort and Pain: The procedure may cause varying degrees of discomfort or pain during or after the treatment. Sensations may include but are not limited to muscle soreness, cramping, or a tingling feeling. b. Skin Irritation: Possible skin reactions, such as redness, swelling, or irritation, may occur in the treated area. These effects are generally temporary but may persist in some cases. c. Muscle Strain: There is a risk of muscle strain or overexertion due to the stimulation of muscle tissues. d. Infection: Although rare, there is a potential risk of infection at the treatment site. Proper aftercare is essential to minimize this risk. e. Adverse Reactions: Individuals with pre-existing medical conditions, or those with implanted devices such as pacemakers, may experience adverse reactions. It is crucial to disclose all relevant medical history to the practitioner prior to treatment. f. Inconsistent Results: Outcomes may vary between individuals, and the effectiveness of the treatment may not meet all expectations. 3. CONTRAINDICATIONS EM Contour treatments may not be suitable for individuals with certain medical conditions, including but not limited to, cardiovascular disorders, pregnancy, or epilepsy. It is imperative to inform the practitioner of any medical conditions, medications, or other factors that may affect the treatment. 4. CONSENT AND ACCEPTANCE By consenting to EM Contour treatments, you acknowledge that you have been fully informed of the potential risks, side effects, and limitations of the procedure. You agree to follow all pre-treatment and post-treatment instructions provided by the practitioner. 5. LIABILITY You agree to release and hold harmless B. Sweet Medspa, its affiliates, employees, and agents from any and all claims, liabilities, or damages arising from or related to the EM Contour treatment, including but not limited to, any adverse effects or complications resulting from the procedure. 6. REFUNDS AND COMPLAINTS Refunds for EM Contour services will not be issued once the treatment has commenced. Any complaints or concerns regarding the procedure must be submitted in writing within 7 days of the treatment date for evaluation and potential resolution. By proceeding with EM Contour treatments, you confirm that you have read, understood, and agreed to the terms and conditions set forth in this disclaimer. *
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INFORMED CONSENT FOR GENERALIZED LASER TREATMENTS

1. Nature and Purpose of Treatment:

I, the undersigned, hereby authorize B. Sweet aesthetics staff and/or such assistants as may be designated, to perform laser treatment on me. 

2. Risks and Potential Complications:

I acknowledge and understand that the laser treatment, like all medical procedures, carries certain risks and potential complications, including but not limited to:

  • Erythema (redness), edema (swelling), and localized discomfort.
  • Temporary or permanent changes in skin pigmentation, including hyperpigmentation and hypopigmentation.
  • Formation of blisters, scabbing, or crusting.
  • Risk of scarring or keloid formation, particularly in individuals predisposed to such conditions.
  • Risk of infection at the treatment site.
  • Possible allergic reactions to post-treatment skincare products.

I understand that while complications are infrequent, they can occur, and the results may vary depending on individual factors.

3. Alternatives to Laser Treatment:

I have been informed of alternative treatments available for my condition, which may include but are not limited to, other laser therapies, chemical peels, topical medications, or no treatment at all. I acknowledge that these alternatives have been explained to me, and I understand the benefits and risks associated with each option.

4. Contraindications and Disclosures:

I have disclosed to the practitioner all pertinent aspects of my medical history, including any history of keloid formation, photosensitivity disorders, or any other conditions that may contraindicate this procedure. I further acknowledge that I am not currently pregnant or breastfeeding, nor am I taking any medications or supplements that may adversely affect the treatment.

5. Pre- and Post-Treatment Instructions:

I have been provided with and understand the pre-treatment instructions, which include but are not limited to avoiding sun exposure and certain medications. I also acknowledge receipt and understanding of post-treatment care instructions, including avoiding sun exposure, applying prescribed ointments, and adhering to follow-up care protocols.

6. Consent to Photographic Documentation:

I consent to the taking of photographs before, during, and after the treatment for the purpose of medical records, education, or marketing, with the understanding that my identity will remain confidential unless otherwise agreed upon.

7. Acknowledgment of Understanding:

I acknowledge that I have had the opportunity to ask questions regarding the nature, purpose, risks, and alternatives to the Pico laser treatment. I confirm that all my questions have been answered to my satisfaction.

8. Voluntary Consent:

By signing below, I hereby give my voluntary consent to undergo laser treatment as proposed. I understand that this consent form does not constitute a guarantee or warranty of the outcome of the treatment.

9. Signature:

I have read and fully understand the contents of this consent form. I am signing this form voluntarily and affirm that I am of sound mind and not under the influence of any substance that could impair my decision-making.

10. Results & expectations

Potential and common side effects that may occur with Picosecond & FOTONA LASER treatments:

• DISCOMFORT may be minimal to moderate. Some areas are more sensitive than others. Topical anesthetic is available for purchase if required. Certain laser treatments include a prescription grade topical anesthetic or can be added on for an additional fee.

• INFLAMMATION which may include irritation, itching, pain, bruising, flaking, ingrown hairs, typically subside/fade in 5-7 days

• ERYTHEMA (redness) and mild to moderate “sunburn” like effects may last for a few hours to 2-5 days

• EDEMA (swelling) of the skin around the treatment site may last 2-5 days, but can be reduced with regular application of a cold gel pack

• PUSTULES or PIMPLES may develop in the first few days following treatment and gradually subside

• TEXTURE CHANGES - Transient texture changes often occur, but usually resolve with time

• BLISTERING, SCABBING or CRUSTING may occur and usually take 4-10 days to heal.

• PETECHIAE may be present after treatment and may last 3 - 5 days. 

• FRECKLES/PIGMENT – Existing freckles/pigment in the treated area may temporarily or permanently disappear

• COINCIDENTAL HAIR REMOVAL – There is a possibility of coincidental hair removal when treating pigmented or vascular lesions in hair-bearing areas

SKIN EXPECTATIONS FOTONA

1. Directly after skin will be pink, feel hot & possibly have pinpoint bleeding

2. Day 1-2 moisturize, the skin will be dry and rough to the touch

3. Day 3-5 skin will feel tight and like sandpaper. Dry & wrinkly looking. Don't worry continue to moisturize. At day 5, use a gentle exfoliate to slough excess skin.

4. Results are not immediate - the skin will improve over time. Be patient, best results at 2 to 3 months.

SKIN EXPECTATIONS PICO

• Redness and swelling after treatment is normal and could last 24-48 hours or longer. May apply cold compress or gel pack to the treated area to help minimize inflammation

• Intense redness including petechia may be present after PICO and may take up to three to five days to resolve

• Multiple treatments at 2-to-4-week intervals are often necessary

• Continue use of pigment regulator (used for pre-treatment) 24 hours after treatment

• SPF 50 mineral sunscreen must be used to protect the face, especially when treating melasma

• Please note: Melasma is one of the toughest skin conditions to treat and it may take several treatments to see results. Maintenance may also be needed to control this skin condition.

You can anticipate the effects of your first round of treatment to last for a long time. Most patients should expect to see the benefits of Pico laser treatments for at least six months before they start to disappear

The results for this treatment will appear gradually as your skin's natural regenerative abilities. For most patients, results are first visible about 2 or 3 weeks after the first appointment. Your results will continue to improve until your last treatment, or until optimal results have been achieved.

SKIN EXPECTATIONS VEIN

1. Immediate Reactions:

  • Redness and Swelling: It's common to experience some mild redness or swelling in the treated area, similar to a sunburn, which usually subsides within a few hours to a few days.
  • Slight Discomfort: There may be a feeling of tightness or mild discomfort, akin to a pulling sensation, but this is generally minimal and short-lived.

2. Skin Reactions:

  • Bruising: Some individuals may notice bruising, which is temporary and typically fades within a week or two.
  • Crusting or Scabbing: Small scabs may form over the treated veins as they are broken down by the body. These should heal naturally without scarring.

3. Post-Treatment Care:

  • Sun Avoidance: It's crucial to avoid direct sun exposure on the treated areas for several weeks to prevent hyperpigmentation or other skin discolorations.

4. Results Timeline:

  • Gradual Fading: Treated veins will begin to fade over the following weeks as the body reabsorbs them. Results are not immediate, and it may take a few sessions depending on the severity of the vein condition.
  • Follow-up Sessions: Depending on the extent of the vein issue, multiple treatments may be necessary to achieve optimal results.

5. Potential Side Effects:

  • Temporary Pigmentation: In rare cases, the treated area may darken or lighten temporarily.
  • Minor Skin Sensations: Some individuals report tingling or numbness in the area, but these sensations typically resolve over time.

Overall, recovery is generally straightforward, and patients can often return to normal activities immediately or within a day or two, depending on their individual case.

 

I have read and understand the above informed consent. The informed consent for generalized laser treatments outlines the following key points: Nature of Treatment: The patient authorizes the staff to perform laser treatment, with the understanding of its purpose. Risks and Complications: Possible risks include redness, swelling, pigmentation changes, blistering, scarring, infection, and allergic reactions. Although complications are rare, they can occur. Alternatives: Other treatments such as chemical peels, topical medications, or no treatment are explained as alternatives. Contraindications: The patient confirms that they have disclosed relevant medical history and are not pregnant, breastfeeding, or taking contraindicated medications. Pre- and Post-Treatment Instructions: Patients are advised to avoid sun exposure and follow skincare protocols before and after treatment. Consent for Photographs: The patient consents to photos for medical or educational purposes, ensuring anonymity. Acknowledgment: The patient confirms they understand the procedure and have had their questions answered. Voluntary Consent: The patient consents to treatment without any guarantee of results. Results and Expectations: Side effects may include discomfort, redness, swelling, blisters, and potential skin texture changes. Results vary, with improvement seen after multiple treatments and over time. Specific expectations are outlined for different treatments (Pico laser, Fotona laser, vein treatment), including skin reactions, post-care, and recovery time. Overall Recovery: The patient can generally return to normal activities shortly after treatment, with results developing gradually over weeks or months. *
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Disclaimer: Informed consent documents are used to communicate information about the proposed treatment of a disease or condition along with disclosure of risks and alternative forms of treatment. The informed consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients in most circumstances. However, informed consent documents should not be considered all inclusive in defining other methods of care and risks encountered. Your physician may provide you with additional or different information which is based on all the facts in your particular case and the state of medical knowledge. Informed consent documents are not intended to define or serve as the standard of medical care. Standards of medical care are determined on the basis of all of the facts involved in an individual case and are subject to change as scientific knowledge and technology advance and as practice patterns evolve. It is important that you read the above information carefully and have all of your questions answered before signing the consent. *
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TERMS OF SERVICE

I acknowledge that beauty and medi spa treatments, including, but not limited to: skin care, massage, microablation, microdermabrasion, waxing, hair and scalp treatments, nail treatments, electrolysis, facial toning, permanent cosmetics, body treatments, ionization, laser treatments, tattoo removal, vein treatments, brown spot removal, BOTOX, Collagen, Dermal Fillers, PRP Injections, Sclerotherapy, Mesotherapy, Dermaplaning, tattoo removal, eyelash extensions, lash lifts and various other beauty procedures is not an exact science and no specific guarantees can or have been made concerning the outcome. I understand that some clients experience more change and improvement than others. In virtually all cases, multiple treatments are required in order to realize a difference. On behalf of myself, my heirs, my executors, and my administrators, I understand and agree to assume the following risks and hazards which may occur in connection with any particular treatment including but not limited to: unsatisfactory results, soreness, poor healing, discomfort, redness, blistering, skin damage, nerve damage, disability, death, scarring, infection, change in skin pigmentation, allergic reaction, eye damage, change or damage to my vision, muscle damage, and increased hair growth. I understand that even though precautions may be taken in my treatment, not all risks can be known in advance. Given the above, I understand that response to treatment varies on an individual basis and that specific results are not guaranteed. Therefore, in consideration for any treatment received, I agree to unconditionally defend, indemnify, hold harmless and release from any and all liability, costs of litigation and any other costs of every kind and nature, the company and the individual that provided my treatment, the insured, their insurance company, and any additional insureds, as well as any officers, directors, or employees of the above companies for any injury, property damage, condition or result, known or unknown, that may arise as a consequence of any treatment that I receive. In the event any provision of this agreement is found to be legally invalid or unenforceable for any reason, all remaining provisions will remain in full force and effect. In the event any provision of this document is found by a court of competent jurisdiction to exceed the limits permitted by any applicable law or to be invalid or unenforceable as written, such court (s) may exercise its discretion in reforming such provision(s) to the extent necessary to make it reasonable and enforceable. The undersigned waives, to the fullest extent permitted by law, any right they may have to a trial by jury in any legal proceeding directly or indirectly arising out of or relating to this agreement whether based in contract, tort, statute (including any federal or state statute, law, ordinance, or regulation), or any other legal theory. The client indicated below understands that any claims are processed through the insurance company’s South Dakota office and agrees that this contract will be governed and construed in accordance with the laws of the state of South Dakota and that all actions of any kind whatsoever will be filed, heard, governed, arbitrated, and restricted to the venue of the County of Meade County, South Dakota. The undersigned also agrees and stipulates that they will be responsible for any legal, or other costs of any kind, incurred by the insured or their insurance company in defense of this agreement should the undersigned challenge its enforceability. The client indicated below also agrees to forever hold harmless and release from any and all liability, claims, or demands of any kind or nature the insured, and their insurance company for the transmission of any disease, condition, injury or illness they may allege to have contracted or been exposed to as the result of any treatment, person, or visit at the insured's location or the location of treatment. I have fully disclosed on my client intake form any medications, previous complications, or current conditions that may affect my treatment. In store public area surveillance footage, text messages, or phone conversations by accessing, using, or continuing to use B. Sweet facilities and services, you acknowledge and agree that any video surveillance footage, text messages or phone conversations (collectively referred to as "Data") collected, recorded, or monitored by B. Sweet may be distributed, shared, or disclosed to third parties for purposes deemed necessary or appropriate by B. Sweet, including but not limited to, security, legal, regulatory, miscommunications, and investigative purposes. You further agree that B. Sweet shall have the right to retain, reproduce, and distribute the Data without further notice or consent, in accordance with applicable laws and regulations. In consideration for treatment received, I hereby grant permission to the individual or company that provided my treatment to use any photographic treatment records for the purposes of clinical and statistical studies, advertising, or additional compensation to me. By providing your contact information, including but not limited to your email address and/or telephone number, you hereby expressly consent to receive marketing communications, promotional offers, newsletters, and other information related to B. Sweet products and services via email, SMS, phone calls, or any other electronic or telephonic means, regardless of whether your number is on any state, federal, or corporate Do Not Call registry. You acknowledge that such consent is voluntary and not a condition of purchase. You further understand that you may withdraw your consent at any time by clicking the "unsubscribe" link provided in such communications or by contacting B. Sweet directly. Withdrawal of consent shall not affect the lawfulness of communications sent prior to such withdrawal. This consent shall remain in effect until revoked in writing or by stop instruction provided by SMS or Mailchimp *
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ENJOY YOUR SERVICE! Thank you for coming - B. Sweet

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