Pro Facial™ Consent Form

This form is designed to give you the information you require to make an informed choice of whether or not to undergo a treatment with Pro Facial™ or Pro Facial Deluxe™, If you have any questions before your treatment please feel free to ask.

  • I hereby authorize this clinic to perform the Pro Facial™ or Pro Facial Deluxe™ treatment
  • The clinic obtained my medical history and found me eligible for treatment
  • I have received the following information about the technology:
    • Pro Facial™ treatment is a non-invasive technology that utilizes Aqua Peeling for skin exfoliation, deep pore cleansing, acne care if required and hydrating the skin on the face and neck
    • Pro Facial Deluxe™ is as above with the addition of any of the following technologies:
      • Radio Frequency which induces heating of the dermal and sub-dermal layers which stimulate a reaction leading to collagen generation
      • Ultrasound to break down the ingredients of nutrients within an applied mask or to break down fat cells with continued treatment
      • ion (micro current) to induce iontophoresis which is pushing the mask ingredients deep into the skin, or to act as a lifting treatment with muscle stimulation 
    • The above treatments create a warm sensation over the skin surface
  • I understand that taking the treatment course is my choice and that I am free to withdraw at any time, without giving any reason
  • I was told about the possible side effects of the treatment including redness (erythema) and swelling (edema), which are transient and will pass shortly
  • The procedures to be used to treat my conditions have been explained to me

1. I have had sufficient opportunity to discuss the treatment. I believe I have adequate knowledge upon which to base an informed consent.
2. Any questions I may have asked have been answered to my satisfaction.

Tap or click on the signature above to sign

Data Protection and Privacy

We are committed to protecting your privacy. We take special precautions with your sensitive personal data and we will process your data lawfully and as described. We only process the data we need for as long as we need to and we respect all of your rights under GDPR. We will never sell, share or otherwise abuse your data. You can contact us at anytime to request your data, change your preferences or request that your data be deleted. GDPR is the European privacy law designed to protect you and give you control of your data.