I duly authorize Canvas Aesthetics (Pty) Ltd to perform the Safyre treatment.
I understand that Safyre is an approved technology consisting of radio frequency and is used for anti-aging, tightening, lifting, firming and cellulite reduction of which I hereby consent to be a client receiving the Safyre treatment on the specified area above.
I understand that clinical results may vary depending on individual factors, including medical history, skin type, client compliance with pre/post treatment instructions and individual response to treatments.
I confirm that I have informed the staff regarding any current or past medical condition, disease or medication taken and that the list of contraindications has been fully explained to me. I also undertake to inform the staff of any changes to my medical condition or medication taken during the course of my treatment or any further future treatments.
I understand that there is a possibility of temporary Short-Term Effects which have been fully explained to me:
- Heat or warmth in area for about 30 min after treatment
- Erythema (redness of the skin)
- Oedema (slight swelling due to the heat)
- Temporary bruising or formation of small red/purple spots caused by slight bleeding under the skin
- Blister/Crusting or Burning
- Scaring
I have been fully informed and understand:
- The treatment involves a series of sessions which need to be continued at set intervals per the clinical trials (2 x per week) – failure to adhere will result in a less desired outcome
- The nature and purpose of the treatments
- Expected outcomes and possible short-term effects
- The final result obtained cannot be guaranteed
- The fee structure including the payment terms and conditions
- The late arrival, no-show and cancellation policies
- My condition is of cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so.
I confirm and understand that the Pre-Treatment Protocols have been fully explained to me and are important and advisable for the desired outcome and that I undertake to / have adhered to these requirements prior to my treatment.
I confirm and understand that the Post-Treatment Protocols have been fully explained to me and I will adhere to these requirements for at least 12 – 48 hours after my treatment. I also acknowledge and understand that Maintenance and additional Home Care Routines are advisable for effective and long-lasting results.
I understand the importance of Before and After Photographs and consent to the following:
- The taking of my before and after photographs
- Authorize their anonymous use for the purposes of medical audit, education and promotion.
I have read and fully understand the contents of this consent form.
