I am voluntarily consenting to a Plasma Lift procedure of the skin. I understand that the procedure can result in an appearance enhancement and is typically used for skin rejuvenation. Plasma Lift is a procedure that can only be performed by a specifically trained and qualified therapist, using approved equipment to shrink the skin using a sterile disposable probe. The therapist is also fully insured.

Before we carry out the procedure, you are required to complete and sign this consultation record, thus giving your absolute consent to treatment. You will need to disclose your full medical history, which will determine your suitability for treatment. If the therapist does not think you are suitable for the treatment, this will not be carried out.

Your therapist will discuss the procedure in full prior to starting the treatment, including what it will involve, the benefits, explain any risks, the healing process and advise upon any further treatment if or where necessary. You will then be provided with written aftercare information for you to keep and refer to during your 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 your responsibility to ensure you understand in full the procedure and the expected outcomes before the 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 therapist. You are signing to state that you understand and accept these terms.
Terms of your treatment:

You have chosen a cosmetic procedure that is not medically necessary.

Plasma Lift is an art process - not an exact science - and cannot guarantee an exact shrinkage result due to skin elasticity and individual healing process and reactions.

You may need additional treatments before your desired outcome is achieved.

Depending upon area of treatment, additional treatments, cannot be performed until after 4-8 weeks from date of your initial treatment. This is in order to allow the treated area to heal fully.

Your therapist will use a treatment plan to record the areas you have chosen, 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 rare cases there may be extreme swelling. Your therapist will give you appropriate aftercare advice to help reduce the risks. Throughout the treatment you may experience some discomfort, this is perfectly normal and you will be reassured throughout.

As the treatment creates small burns to the skin, you may experience the smell of charring or burning, this is a direct effect of the treatment and nothing to be concerned about.

You must adhere to the therapist’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 salon. 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 and requiring further treatments.

Please be aware that skin altering procedures such as plastic surgery, implants, injectable’s or weight gain may alter the Plasma Lift look.

procedure indicated below and please acknowledge or answer the points and questions:

I confirm that to the best of my knowledge that the information that I have supplied is correct and that there is no other medical information I need to disclose.

I understand that the practice of medicine and surgery is not an exact science and therefore that no guarantee can be given as to the results of the treatment referred to in this document. I accept and understand that the goal of this treatment is improvement, not perfection, and that there is no guarantee that the anticipated results will be achieved.