Treatment Follow- up Form

I confirm that I have been informed about:

• The specific product(s) to be used.

• The intended treatment area(s).

• The potential benefits of this further treatment.

• The potential risks and side effects associated with this further treatment, which may include but are not limited to:

  • Bruising

  • Swelling

  • Redness

  • Tenderness

  • Pain

  • Temporary numbness

  • Rarely, more serious complications as discussed.

• The expected duration of the results, which can vary depending on the individual and product used.

• The aftercare instructions that I will need to follow to ensure optimal healing and results.

• The cost of this further treatment, if required.

I have had the opportunity to ask questions and have received satisfactory answers. I understand that the results of cosmetic treatments can vary, and no guarantees have been made regarding the final outcome.

Statement of Consent:

By signing below, I confirm that:

• I am the patient named above and am over 18 years of age.

• I have voluntarily chosen to proceed with this follow-up review and/or further treatment.

• I have been given sufficient information and time to make an informed decision.

• I understand and accept the potential benefits and risks associated with the proposed treatment.

• I agree to adhere to any pre- and post-treatment instructions provided by Tiara Aesthetics.

• I consent to photographs being taken for my medical record, if deemed necessary.