Facial and Jawline Intake and Consent

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Consultation - What is your primary reason for scheduling this treatment?
Health and Safety
Photo Tracking - Consent to Obtain and/or Release Photos

Consistent photos are the best way to track your progress and know to make modifications to your treatment plan if needed. I require photos for Cryo chin slimming and all Exilis services.  Photos will be kept strictly confidential unless explicity stated otherwise.  As these services work with consistency and time, I encourage you to take your own photos 2-6 weeks after your treatments as well.  I do not require photos for Cryofacials.  

**Gift card eligibility requires 3+ treatments, according to your treatment plan. Visits must be spaced within 14 days apart, and will be redeemed at the time of your final after photo, which must be taken within 2-6 weeks after your final treatment.

Failure to follow treatment guidelines or come in for your after photo forfeits your giftcard, but does not negate your consent to photo sharing.  If you receive additional treatments after your gift card is received, photos may continue to be shared, with no additional compensation.  

 

Explanation of Risks

When performed properly and when the client does not have contraindications or pre-existing conditions, the health and safety risks for Cryofacials are very minimal. Cryofacials and CryoToning treatments work by using a cold massage wand, followed by a massage stroke, to create microtrauma to the area and biohack your body to produce more collagen and elastin. This sudden increase in circulation may cause redness to the skin that typically fades in minutes, but may last up to 48 hours. Also rarely, the skin may produce small bumps in reaction to the treatment, which should also clear up within 48 hours.

CryoSlimming treatments work by warming the area, then a specific cold temperature shocks and freezes subcutaneous fat cells.  This is followed by heat to bring circulation back to the area and initiate flushing out the dead cells. Paradoxical Adipose Hyperplasia (PAH) is a rare but known side-effect of cryolipolysis treatments such as CoolSculpting, but there has never been a reported case following CryoSkin treatment.  Redness, mild soreness, or skin irritation may occur and typically fades within hours.  Rarely, bruising and severe soreness may occur and should subside within 48 hours.  These side effects typically occur due to an unknown pre-existing condition, or practitioner error. 

Exilis Ultra Radiofrequency uses monopolar technology to pull heat into the subdermis,  creating a thermal injury and stimulating deep collagen and elastin production.  It is crucial to be well hydrated for these treatments.  The heat is intense, but should not feel painful.  The practioner relys on verbal feedback from the client to keep your treatment comfortable and avoid burns.  It is important to avoid direct sunlight, hot tubs, saunas, and any extreme heat for 48 hours after your treatment.  There may be redness and/or mild discomfort immediately after the treatment, which should subside within an hour, but in rare cases can last up to 48 hours.  

By signing below, you agree to the following terms, conditions, and risks associated with receiving Cryofacials and other services with Vital Spark Co:

1. I have read and understand the list of health contraindications for CryoSkin services, and have fully disclosed any medical concerns prior to treatment. Should any changes in my health occur, I will notify my provider before resuming treatment. 

2. I agree to alert my practitioner of any undiagnosed swelling, signs of infection, shortness of breath, or extreme fatigue prior to each treatment. My practitioner is unable to diagnose my condition, but will advise me that treatment may not be safe, and refer me to my physician or urgent care. 

3. I understand that common side effects include temporary redness, minor skin irritation and, rarely, numbness. This will typically fade within a few hours, and I will notify my provider if I am experiencing discomfort after 48 hours of receiving my treatment.  

4. If my treatment becomes painful or uncomfortable at any time, I will let my provider know immediately.  I understand that it is my responsibility to communicate with my provider if I am experiencing discomfort.  

5. For slimming treatments, I have been advised regarding before & after care on my treatment days. I acknowledge that if I do not follow this protocol, my treatment may not be effective, and some temporary swelling and/or discomfort may occur.  

6. I assume full responsibility for any and all injuries or damage which are sustained or aggravated by me in relation to my receiving of CryoSkin services, and release, indemnify, and hold harmless Vital Spark and the distributor and manufacturer of any equipment, device, or product used during the CryoSkin services, their respective direct and indirect parent, subsidiary affiliate entities, and each of their respective officers, directors, members, employees, representatives and agents, and each of their respective successors and assigns and all others, from any and all responsibility, claims, actions, suits, procedures, costs, expenses, damages, and liabilities to the fullest extent allowed by law arising out of or in any way related to the Services; and represent that: (a) I have no medical or physical condition that would prevent me from receiving the Services, (b) I do not have a physical or mental condition that would put me in any physical or medical danger, (c) I have not been instructed by a physician to not receive CryoSkin services or similar services, (d) no warranty or guarantee, or other assurance, has been relied upon or made to me concerning the results of CryoSkin services’ effects and side-effects, (e) knowing the risks involved, I nevertheless chose to voluntarily request CryoSkin services, (f) I am not currently under or suffering from the effects of any prescribed medication, illicit drugs, or alcohol and further representhat that I am of sounds mind and make all representations freely and voluntarily, and (g) the CryoSkin ervices provided do no constitute medical or health carte services and that employees and associates of the Company are not health care practitioners and cannot diagnose and/or treat individual health problems.. Notwithstanding the foregoing (and by way of illustration only and not limitation) if any of the following apply to me or if I’m unsure for any reason, I hereby acknowledge the Vital Spark’s recommendation that I consult a medical physician before receiving Services. 

7. I acknowledge that while my provider(s) does their best to assess my areas of concern and determine if CryoSkin will work and the type/recommended number of treatments, every person responds differently and my results are not guaranteed. Additional treatments may be recommended to achieve desired results.

8.  I understand that maintaining a healthy lifestyle is essential for receiving optimal results. This includes a balanced, moderated-carb diet, regular exercise, and staying hydrated (drinking a minimum of half my body weight (in pounds) in ounces per day).  

9. I understand that slimming results are permanent in the sense that the fat cells die and are removed from the body via the lymphatic system. However, it is possible that the body will continue to store subcutaneous fat cells in my target area and regular sessions may be needed to maintain results. I am aware that my diet, fitness level and lifestyle will play a role in maintaining my results.  

10. I understand and acknowledge that toning and cryofacial results are temporary, as we do continue to age over time. My provider has assessed my treatment area and has done their best to inform me of how many and what type of treatments are recommended, and how long results will last. However, every body responds to treatment differently, and maintenance treatments are recommended.  

11. I agree that payment for my set number of treatments has been predetermined and is required in full prior to, or at the time of my first treatment. My payment is non-transferable and non-refundable.

12. I agree that 24 hour notice is required for rescheduling or canceling my appointments. In the event of a late cancellation or no-call/no-show, I understand that Vital Spark charges a $120 missed appointment fee. If I chose not to pay this fee, I understand that my pre-paid appointment will be sacrificed and is not refundable. This policy does not apply in the event of injury or illness, in which case I am advised not to receive CryoSkin treatments. A doctor’s note may be requested in the event of multiple late cancellations or no-shows due to illness.

13. I understand that my practitioner will do their best to accommodate my session if I am late to my appointment. However, being more than 10 minutes late may qualify as a missed appointment.  My treatment may be shortened if I am late, and I am still required to pay for my appointment in full.

 

I have read and fully understand risks, limitations and contraindications for CryoSkin treatments, as well as the terms and conditions for receiving services. I hereby consent to CryoSkin treatments performed by Vital Spark practitioners.

Review & Agree