June 21, 2025 Plasma Soft Surgery Treatment is a procedure that can only be performed by a specifically trained and qualified specialist therapist. Using approved equipment to shrink the skin using a sterile disposable probe.
Before carrying out the treatment, you are required to complete and sign this consultation record, thus giving your absolute consent to treatment. Additionally, you will need to disclose your full medical history, which will determine whether you are a suitable candidate for the proposed treatment. If the specialist does not think you are suitable for the treatment, this will not be carried out.
Your specialist will discuss the procedure in full, including what it will involve, discuss the benefits, explain any risks, the healing process and advise upon any further treatment if / where necessary. You will then be provided with written aftercare information for you to keep and refer to during the subsequent healing process.
Contra-indications will be recorded on this consultation form, which will be used as a reference for future visits.
It is important you clearly mark any areas of this form you wish to have clarified or discuss further. It is ultimately YOUR responsibility to ensure you understand in full the procedure and the expected outcomes before treatment commences.
PLEASE READ CAREFULLY AND SIGN WHERE INDICATED, ONLY when you are happy to proceed. Ensure all points below have been discussed with your specialist. You are signing to state that you understand and accept these terms.
Terms of your treatment: oYou have chosen a cosmetic procedure that is not medically necessary.
-Plasma pen lifting is an art process - not an exact science - and cannot guarantee an exact shrinkage result due to skin elasticity and individual healing process.
-You may be required to return for additional treatments before your overall procedure is deemed complete. The payment for any additional work, (if applicable), will be agreed prior to the treatment commencing. Depending upon area of treatment, additional treatments, cannot be performed until after 4-8 weeks from date of initial treatment. This is in order to allow the initially treated area to heal fully.
-Your specialist will use a treatment plan to record the areas you have chosen, anaesthetic used, probe used as well as pre and post treatment photographs. This information will be held securely in your consultation record.
-The skin type of every client is different and the healing process may lead to some discolouration of the skin. (Microdermabrasion or skin rejuvenation) may be advised, after the healing process is complete.
-After each treatment some swelling or redness may occur. In some cases there may be extreme swelling. Your specialist will give you appropriate advice to help reduce this risk. Throughout the treatment you may experience some discomfort, but your specialist will reassure you throughout and endeavour to make you feel comfortable.
oSince the treatment includes small burns to the skin, you may experience the smell of charring. This is perfectly normal.
-You must adhere to the specialist’s aftercare advice given to you following your treatment. This is very important and will reduce the risk of post procedural infection upon leaving the clinic. You must let the treated area heal properly. Avoid picking, plucking or knocking as this will hinder the healing process and could make the treatment appear uneven thus requiring further work.
-Be aware that skin altering procedures such as plastic surgery, implants, injectable’s and weight gain may alter the look
-By signing and initialing this waiver of liability form you are legally agreeing and adhering to the following terms & conditions: -Results are never 100% guarenteed & we cannot control how your body responds to any treatment whatsoever. We are 100% FREE of ANY liability whatsoever associated with your personal results from any treatment preformed at House of Wax LLC becaus ethis is an elective cosmetic procedure you are selecting at your OWN RISK. House of Wax will NOT be slandered on any public forum WHATSOEVER following ANY procedure or service preformed at the salon. All concerns & any possible dissatisfaction MUST be addressed with your artist personally & NOT taken to social media of any form. Slander & libel are serious offenses & legal action will be taken if any violations of any terms listed on this waiver are violated.
House of Wax LLC is not responsible for ANY reactions/risks associated with any treatments preformed because YOU ARE SELECTING THIS SERVICE AT YOUR OWN RISK & YOU ARE RESPONSIBLE FOR RESEARCHING & KNOWING RISKS & SIDE EFFECTS BEFOREHAND & ARE LEGALLY SIGNING OFF THAT HOUSE OF WAX LLC WILL NOT BE HELD FINANCIALLY RESPONSIBLE FOR ANY OUTCOME WHATSOEVER.
June 21, 2025
DO YOU AGREE TO ALL TERMS LISTED ON THIS WAIVER?
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