Treatment Declaration

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General Declaration

This is an informed consent document that has been prepared to help inform you concerning treatment and the risks involved. It is important that you read this information carefully and completely.

Please complete each section relating to your selected treatments, indicating that you have read the page and sign the consent at the bottom prior to your treatment.

PUBLICITY MATERIALS I authorise the taking of clinical photographs and videos. I understand that photographs and video may be taken of me for educational and marketing purposes. I hold the practitioner harmless for any liability resulting from this production. I waive my rights to any royalties, fees and to inspect the finished production as well as advertising materials in conjunction with these photographs.

Treatment Specific Disclaimers

INTRODUCTION: Anti-Wrinkle injections involve a series of small injections in order to weaken the chosen muscles. The weakening of the injected muscles begins to be apparent after 2-3 days with the peak effect being reached after 10-14 days. Results can last 3-6 months.

The procedure can be repeated after 3 months; however, injections given less than 3-month intervals may reduce the efficacy of the injections.

RISKS AND SIDE EFFECTS: Every procedure involves a certain amount of risk, and it is important that you understand the risks involved. An individual's choice to undergo a procedure is based on the comparison of the risk to potential benefit.

Botox treatment is a safe and low risk procedure, but you must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.

Although the majority of patients do not experience these complications, you should discuss each of them with your practitioner to make sure you understand the risks, potential complications, and consequences of Anti-Wrinkle injections:

Bleeding, Bruising/Swelling, Infection & Unsatisfactory Outcome/Temporary loss of function of nearby muscles.

INTRODUCTION: Dermal filler treatment with dermal fillers can smooth out facial folds and wrinkles, add volume to the lips, and contour facial features that have lost their volume and fullness due to ageing, sun exposure, illness, etc.

Dermal Filler treatment is a safe and low risk procedure, but you must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.

It has been explained to me that there are certain inherent and potential risks and side effects in any invasive procedure and in this specific instance such risks include but are not limited to:

1) Post treatment discomfort, swelling, redness, bruising, and discolouration

2) Post treatment infection associated with any transcutaneous injection

3) Allergic reaction

4) Reactivation of herpes (cold sores)

5) Lumpiness, visible yellow or white patches

6) Granuloma formation

7) Localised necrosis and/or sloughing, with scab and/or without scab if blood vessel occlusion occurs.

INTRODUCTION: Profhilo is a skin bioremodeller consisting of high concentration hyaluronic acid. It works by stimulating skin collagen and elastin production as well as promoting increased skin hydration. Profhilo is administered in small amounts by intradermal injection using very fine needles and aims to boost, tighten, hydrate and lift your skin. Profhilo is used to treat tired, aged, lax and dehydrated skin as well as for fine lines and wrinkles.

Profhilo is injected on two treatment sessions 4 weeks apart, to maintain results a further 2 treatment course is recommended every 6 months. After initial treatment you can expect to see results gradually over a period of 4-6 weeks. Results should last 6 months on average but they can last for longer or shorter time periods. I am aware that results vary between clients and results are dependent on many individual factors.

I am aware that there is no guarantee that I will achieve desired results and that more than one treatment course may to be needed to achieve or maintain desired results.

Profhilo treatment is a safe and low risk procedure, but you must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.

Pain, bleeding and bruising at the time of injection. After injection, the area may feel tender but should not be actively painful. If you experience significant pain following Profhilo then you must contact your practitioner as soon as possible for review. Bruising is dependent on several factors, most of the time bruising is mild but occasionally can be more significant. Bruising can take up to 2 weeks to fully resolve but should be much improved after 1 week.

It has been explained to me that there are certain inherent and potential risks and side effects in any invasive procedure and in this specific instance such risks include but are not limited to:

1) Post treatment discomfort, swelling, redness, bruising, and discolouration

2) Post treatment infection associated with any transcutaneous injection

3) Allergic reaction

4) Reactivation of herpes (cold sores)

5) Lumpiness, visible yellow or white patches

6) Granuloma formation

7) Localised necrosis and/or sloughing, with scab and/or without scab if blood vessel occlusion occurs.

INTRODUCTION: Radio Frequency treatment is a non-surgical facelifting and body contouring treatment which tightens, smooths and contours the skin. Radio Frequency treatment works by using radio frequencies which are transmitted by a handpiece into the dermis layer of the skin causing heat production. The process triggers new dermal collagen formation resulting in younger tighter and smoother looking skin. Radio Frequency treatment may also help smooth out fine lines and wrinkles and can be used to help reduce cellulite.

Radio Frequency treatment can be used to treat loose skin on the neck, jawline, face, legs, abdomen and other body areas. You may experience a warming feeling during the treatment but the procedure is not painful. Other advantages of Radio Frequency treatment: non-invasive, no injections or anaesthetic needed and little to no downtime afterwards. Results are gradual and evolve over a 2-3 month period. Effects can be expected to last for 2-3 years.

I am aware that results vary between clients and results are dependent on many individual factors. I am aware that there is no guarantee that I will achieve desired results.

Radio Frequency treatment is a safe and low risk procedure, but you must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.

Common risks of Radio Frequency treatment include that it may not be effective with advanced and resilient skin problems. You may also have some mild swelling and redness in the treatment area for 2-3 days afterwards but occasionally can last longer.

Uncommon risks include changes in skin pigmentation to lighter or darker, this usually resolves within 6 months but in rare cases could be permanent. Sometimes you may experience some temporary bumps or skin indentations, but these usually resolve naturally.

Rare risks of Radio Frequency treatment include pain, tingling or burning sensation after treatment, bruising, blisters, skin burns, permanent scarring or skin indentations are extremely rare risks. In the event of any of these you should consult your practitioner and seek medical advice.

I have been advised of the relevant information associated with this treatment and I confirm that I fully understand this advice. This includes advice about:

- the aims/motivations for having the procedure and the desired outcome

- the risks inherent in the procedure

- the risks inherent in refusing the procedure

- the risks specific to me

- the expected benefits of the treatment

- the potential disadvantages of the treatment

- alternative procedures and their pros and cons - including the option of -no treatment at all

- any uncertainties about and the likelihood of success of the procedure

- any follow-up treatment that may be required

INTRODUCTION: Fibroblast treatment is also known as Plasma or Plasma Pen, it involves the use of a special pen-like device which is used to send an electric current through small pinpoints on the skin. The plasma pen does not touch the skin but rather it releases the electric current just above the skin causing pinpoint controlled burns (micro holes) in the skins surface. The surrounding skin contracts around them leading to firmer, tighter younger looking skin. The treatment also stimulates fibroblast activity and tissue regeneration.

Fibroblast Plasma can be used to treat fine lines and wrinkles, small scars and stretch marks, age spots, acne scars, loose skin on the neck, eyelids, and lip lines. You may notice some instant improvements after treatment, but maximum effects can take up to 12 weeks. Results can last up to 5 years but this is dependent on many factors. Results vary between clients and are dependent on many individual factors. There is no guarantee that you will achieve desired results and that more than one treatment may to be needed to achieve or maintain desired results.

Immediately after treatment it is normal to see multiple small dots on the skin that will scab over, these multiple tiny scabs will heal over after about 1 week. You will be offered a topical anesthetic cream to help reduce any discomfort during the procedure.

RISKS AND SIDE EFFECTS: As with any procedure there are potential risks and complications associated. You must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.

Common side effects of Fibroblast Plasma include pain, tenderness, redness of the skin after treatment, swelling, scabbing, skin peeling and crusting. It will also be normal that your skin will be more sensitive to sunlight afterwards and you will need to use SPF sunscreen following the treatment.

Uncommon side effects include severe swelling, slow resolving eyelid oedema, bacterial skin infection (cellulitis), reactivation of cold sores (herpes simplex infection), skin pigmentation changes to lighter or darker which occasionally may be permanent.

Rare side effects include skin burns and permanent scarring. This may occur if the plasma pen is overused or its use is prolonged, however other causes may be involved. Your practitioner will also check that you do not have any underlying skin or medical conditions that may increase you risk of infection, burns or scarring. In the case of skin burns or infection following Plasma Fibroblast you would need to seek medical attention.

I have been advised of the relevant information associated with this treatment and I confirm that I fully understand this advice. This includes advice about:

- the aims/motivations for having the procedure and the desired outcome

- the risks inherent in the procedure

- the risks inherent in refusing the procedure

- the risks specific to me

- the expected benefits of the treatment

- the potential disadvantages of the treatment

- alternative procedures and their pros and cons - including the option of no treatment at all

- any uncertainties about and the likelihood of success of the procedure

- any follow-up treatment that may be required

INTRODUCTION: Every patient is unique in terms of what their goal is and how their skin tag/mole presents itself, which ultimately determines the technique required for its removal. During your appointment your lesion will be removed under local anesthesia in the clinic under sterile conditions.

A dressing may be applied. You will be given instructions on how to care for the site. You may be required to visit the clinic for a follow-up appointment.

Technique for removal will be via plasma pen (this treatment refers to the removal of skin lesions by heat).

Ideal candidates for lesion removal are going to be those with smaller moles, lipomas, fibromas, skin tags, warts, age spots, and/or sun spots.

Skin Tag/Mole Removal treatment is a safe and low risk procedure, but you must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.

Removing skin tags can cause scarring or darken skin (hyperpigmentation) where the skin tag was, particularly on black or brown skin. These effects are usually temporary, although it can sometimes be permanent.

Here are a few tips on what we recommend to avoid after removal:

1) Avoid any cosmetics that would give irritation to the skin;

2) Do not to pull at any scab formation;

3) Do not receive any beauty treatments that would affect the area before it has healed.

INTRODUCTION: Dermaren Lumi Eyes is a tissue stimulator designed for needle mesotherapy treatments around the eyes and the tear valley with a filling effect. Lumi Eyes is a high-quality product that repairs damage to the dermis with polynucleotides with a strong tissue regenerating effect . The effect of the treatment is strong hydration and rejuvenation of the tissue, as well as the reduction of symptoms of fatigue and skin blueing.

Polynucleotide PDRN is used to regenerate damaged tissues, moisturise, restore volume, and smooth skin. PDRN is a low molecular weight complex that affects the repair of cells and damaged tissues, homeostasis from the inside. The mechanism of action of the substance is to stimulate the active synthesis of collagen, which helps to restore the DNA chains and increase the production of its own elastin. Glutathione, in turn, is responsible for the antioxidant effects during the biorevitalisation procedure.

Lumi Eyes is a high-quality injection product based on polynucleotides (obtained from purified salmon milk DNA) that repair damage to the dermis with tissue regenerating material. Ruthlessly destroys dark circles under the eyes, moisturises and fights fine wrinkles, as well as smoothing and lifting the skin under the eyes. As a tissue booster, it has a proven rejuvenating effect. Stimulation of the skin cells, collagen and elastin allows to delay the ageing processes and strengthens the skin. It improves the firmness, density and quality of the skin in an extremely natural way. Dermaren Lumi Eyes stimulates the skin to self-regenerate. Thanks to the absorption speed there is no downtime with this treatment, you can return to your normal daily life straight after the treatment.

Dermaren Lumi Eyes allows you to achieve a perfect effect after just one treatment. For better results, it is recommended to perform a series of 3 treatments with an interval of 4 weeks and repeat the treatment twice a year. The skin will gain energy and freshness, while reducing bruising and fatigue.

Lumi Eyes treatment is a safe and low risk procedure, but you must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.

There are some rare and mild side effects to be aware of with Lumi Eyes. These include mild swelling at the application site, slight redness, small injection marks, mild bruising, erythema, itching, and potential allergic reactions. Side effects can be discussed during your free consultation.

INTRODUCTION: The Lemon Bottle is an aesthetic treatment product designed specifically for fat dissolution. It involves a solution that is injected into fat pockets to facilitate fat breakdown and enhance the body's natural fat removal processes.

The treatment procedure involves the injection of the Lemon Bottle solution into specified areas of fat accumulation. It is a non-surgical procedure performed by a licensed practitioner. The procedure duration and number of sessions required may vary based on individual needs and the amount of fat to be dissolved.

The Lemon Bottle fat dissolving treatment can offer several potential benefits including reduction of localised fat pockets, improvement in body contour, and enhancement in overall body appearance.

Fat Dissolving treatment is a safe and low risk procedure, but you must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.

While the Lemon Bottle fat dissolving treatment is generally considered safe, it comes with potential risks. These may include but are not limited to:

- Localised pain, swelling, redness or bruising at the injection site.

- Potential for an allergic reaction to the product.

- Possibility of infection if aftercare instructions are not properly followed.

- Temporary changes to skin texture or irregularities in body contour.

INTRODUCTION: Platelet Rich Plasma, also known as PRP, is derived from the patient’s blood in the following manner. A fraction of blood (60cc) is drawn from the individual patient into a syringe. This is a relatively small amount compared to blood donation. The blood is spun in a special centrifuge to separate its components (Red Blood Cells, Platelet Rich Plasma, Platelet Poor Plasma and White Blood Cells).

PRP is autologous (using your own blood) therefore eliminating allergy potential. PRP has been shown to have tissue regenerating effects. Other benefits include: minimal down time, safe with minimal risk, short recovery time.

Microneedling is a skin treatment used to rejuvenate the skin and improve the skins surface. It can be used to improve the appearance of fine lines, expression lines, wrinkles, enlarged pores, and acne scars, hyperpigmentation and stretch marks. As the microneedling device moves across the skin, it makes multiple small needle punctures in the skin’s outer epidermis layer, creating very minor micro injuries. In response to the perceived injury, new collagen synthesis is triggered and the micro holes created allow passage of healing serums. These treatment effects aim to produce overall skin rejuvenation.

The microneedling device is used to make multiple small micro needle punctures in the skin. Basic micro needling treatment includes the application of serums during the procedure. When microneedling is administered as a part of the vampire facial, the patient's own blood-derived growth factors and platelet rich plasma (PRP) are applied during the procedure. The entire procedure is normally completed within 30-60 minutes depending on the required treatment and the anatomical site.

More than one treatment will likely be required to achieve or maintain results, but this depends on the treatment aim and client response to treatment. Results can be seen at 2-3 weeks after treatment, but peak results are usually seen at 4-6 weeks. The duration of results varies between clients and there is no guarantee that you will achieve desired results. Microneedling does not prevent recurrence of the condition being treated.

Platelet Rich Plasma (PRP) treatment is a safe and low risk procedure, but you must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.

Potential Side Effects of Platelet Rich Plasma include:

1. Pain at the injection site

2. Bleeding, Bruising and/or Infection as with any type of injection

3. Short lasting pinkness/redness (flushing) of the skin

4. Allergic reaction to the solution, and/or topical anaesthetic

5. Injury to a nerve and/or muscle as with any type of injection

6. Itching and swelling at the injection site(s)

INTRODUCTION: BioRePeel is a bi-phase TCA (trichloroacetic acid) peel with a patented formula that works to reduce the appearance of fine lines, wrinkles, and other signs of ageing. It also targets imperfections such as enlarged pores and hyperpigmentation. The procedure involves applying the BioRePeel solution to the skin, which will then be left on for a specific period before being neutralised or removed.

Multiple treatments are often required to obtain optimal results spaced 4 weeks apart, due to variables such as age, condition of your skin, sun damage, smoking, skincare products, climate, lifestyle, and general health.

The skin can take up to 14 days to heal after a chemical peel and repeat peels should not be done within this 2 week period. You should have repeat peels at 4-6 weeks.

BioRePeel treatment is a safe and low risk procedure, but you must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.

I understand that the risks and possible complications associated with a BioRePeel procedure include but are not limited to:

Redness, swelling, and peeling of the skin, which typically resolve within a week.

Temporary or permanent changes in skin colour, particularly for those with darker skin.

Scarring.

Infection.

Allergic reactions, although extremely rare, may occur.

INTRODUCTION: Vitamin B12 is also known as Cobalamin, it is a water-soluble vitamin essential for both fatty acid and amino metabolism as well as DNA synthesis. It is vital for the normal functioning of the nervous system, myelin sheath production and red blood cell maturation and development.

Vitamin B12 deficiency has a broad presentation including fatigue, anemia, multiple neurological and psychiatric signs and symptoms.

Replacement of vitamin B12 is in the form of Hydroxocobalamin given by intramuscular injection.

An intramuscular injection of B12 is given into the Deltoid muscle in the side of the upper arm. The procedure is very quick, you may feel a short, sharp pain during the injection.

It is important that you see your doctor/GP if you suspect or display symptoms of B12 deficiency. It is important also to not exceed the recommended doses of B12.

Vitamin B12 treatment is a safe and low risk procedure, but you must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.

You must be aware of the following side effects of intramuscular vitamin B12 injection before commencing treatment. You must fully discuss any questions with your practitioner before proceeding.

I understand the common side effects are pain during injection, redness, swelling and soreness around the injection site lasting up to a few days. You may also experience some bruising around the injection site also. Some people can faint or feel faint with needles and injections, it is important to tell your practitioner as soon as possible if you feel unwell during or after the injection.

Uncommon side effects include dizziness, headache, nausea, vomiting, hot flushes, skin reactions, chills, tremor, insomnia.

Rare side effects include cardiac arrhythmias, thrombocytosis, hypokalemia (low blood potassium level). There is also a rare risk of allergic reaction or anaphylactic reaction to the B12 injection. In the event of anaphylaxis or any serious side effects, you would require emergency medical attention.

I have been advised of the relevant information associated with this treatment and I confirm that I fully understand this advice.

INTRODUCTION: IV infusion therapy involves the insertion of a venous canula into a vein in you hand or arm. A bag of IV fluid is then infused into your bloodstream via the cannula. The fluid is based on sodium chloride with various preparations available, usually with multi-vitamin combinations.

You must inform the practitioner of any known allergies to medications or other substances and all current medications and medical conditions. The infusion fluid of choice will be decided after discussion with your practitioner and prescriber. Alternatives to intravenous therapy are oral supplementation and/or dietary and lifestyle changes.

Intravenous infusion therapy and any claims made about these infusions are not intended to diagnose, treat, cure, or prevent any medical disease. These IV infusions are not a substitute for any medical care. The main intended benefits of IV infusion therapy are rehydration and vitamin and mineral supplementation.

Vitamin IV treatment is a safe and low risk procedure, but you must be aware of the following possible risks before proceeding. You must fully discuss any questions with your practitioner.

Common complications with IV infusion therapy include

1) Pain during cannula insertion, bruising, pain at the site of injection

2) Failed canulation attempt/s requiring further needle entries to gain venous access.

3) Tissuing of the cannula where fluid from the IV drip bag is infused into the skin if the cannula is not sited in the vein or dislodges. This would result in pain and swelling of the skin around the cannula

4) Uncommonly an inflammatory reaction in the skin can occur.

In the event of tissuing the cannula must be removed. Some people can faint or feel faint with injections, you must tell your practitioner as soon as possible if you feel unwell during the treatment.

Uncommon complications include skin/ tissue infection (cellulitis), vein inflammation (thrombophlebitis), venous injury and haematoma.

Rare complications of IV infusion therapy include fluid overload, electrolyte disturbances, injury to a nerve or artery in the hand or arm during cannula insertion.

What are your aims/motivations for having the treatment(s) and your desired outcome?

Please provide further information regarding any questions that you have answered "Yes" to above.

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Treatment Declaration

General Declaration

Botox Disclaimer

Dermal Filler Disclaimer

Profhilo Disclaimer

Radio Frequency Disclaimer

Fibroblast Plasma Therapy Disclaimer

Skin Tag/Mole Removal Disclaimer

Lumi Eyes Disclaimer

Lemon Bottle Fat Dissolving Disclaimer

Platelet Rich Plasma (PRP) Facial Disclaimer

BioRePeel Chemical Peel Disclaimer

Vitamin B12 Disclaimer

Vitamin IV Disclaimer