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Plamere Plasma Consultation and Consent Form

Client Information

The Procedure

It is imperative that you discuss any areas of this form that you do not understand, or any concerns you may have, with the practitioner prior to treatment. It is your responsibility to fully understand the procedure and expected outcomes before the treatment starts.

Ensure all points below have been fully discussed and understood. When ticking each statement, you are stating that you understand and accept the terms of this treatment.

Please read carefully and sign ONLY if/when you feel comfortable to proceed.

You have chosen a cosmetic procedure that is not medically necessary.
Plamere Plasma is an art process-not an exact science- and can not guarantee an exact shrinkage result due to individual skin elasticity and healing process.
You may be required to return for additional treatments before your overall procedure is deemed complete. The payment and time frames for any additional work will be discussed and agreed upon prior to the treatment commencing. Dependent on the area of treatment, additional treatments can not be performed sooner than 4 weeks or later than 8 weeks after the initial and subsequent visits. It is imperative for the area to fully heal prior to additional treatments.
A treatment plan record will be kept by your practitioner to record area’s you have chosen, anaesthetic used as well as pre and post treatment photos.
The skin type of each guest is different and the healing process may lead to mild discoloration of the skin. Microdermabrasion treatments may be suggested after the healing process is complete.
After each treatment, swelling and redness may occur. Some guests may experience extreme swelling. You will be given advice on how to reduce and minimise the risk.
The treatment includes a small burn to the skin, you may experience a smell of charring. This is completely normal.
You must adhere strictly to the specific aftercare advice provided to you following your treatment. Doing so is extremely important and will greatly reduce the risk of post procedural infection upon leaving the Clinic.
Treated area must heal properly. Picking, plucking, scrubbing or manipulating the treatment area could make the treatment area appear uneven, discolored or scarred, requiring further work.
Beware that cosmetic or medical skin altering procedures such as plastic surgery, implants, injectables and weight loss or gain may alter the Plamere Plasma treatment look.

Photographic Consent

I consent to photographs being taken before, during and after each procedure. I agree to these photos being stored electronically in my case file and will be used only with my written consent for promotional purposes.

Tap or click on the signature above to sign

Patch Test

I have undergone or been offered an allergy test prior to my initial treatment. I therefore release the practitioner from liability related to any allergic reaction I may experience associated with either the application of the pretreatment cream or any other products used before during and after my procedure immediately or at a later date.

Tap or click on the signature above to sign