INFORMED CONSENT FORM FOR REGIONAL SLIMMING PROCEDURE
The purpose of the explanations in this form is not to worry you, but to enlighten you in a scientific framework about the before, during and after of the procedure and its possible risks. Please read carefully. If you have questions or points you do not understand, ask for help.
1. Personal Information
Please fill out this section completely.
Name:
Surname:
Date of birth:
Gender:
Mobile number:
Signature:
2. Regional Slimming What is its application and for what purpose is it used?
Regional slimming is the practice of removing excess fat in body parts that are difficult to melt despite diet and exercise, with cosmetic devices, without surgical or medical intervention. In regional slimming processes, we apply mechanical vibration (G5), sound energy (cavitation), RF energy and galvanic current technologies to areas with excess regional fat with massage movements using ultrasound gel, lubricating oils and creams. In this way, heat is created in the fat tissue and skin for tightening purposes. With the effect of heat, the fatty tissue is damaged and shrinks and collagen synthesis in the skin is increased, eliminating the cellulite appearance and tightening. Since regional slimming is applied to the fat tissue in a specific area, it does not have a weight loss effect. It is used to remove excess fat that is difficult to melt despite diet and exercise in the abdomen, side bagels, lower abdomen after cesarean section, hips, inner legs, buttocks, upper arms, back area and jowl area. The effect of regional slimming varies from person to person, and in general, less melting is observed in low fat and more melting is observed in excess fat. You will be notified at each session of your slimness by measuring with a tape measure before and after the application. To increase the success of regional slimming, diet, exercise and drinking plenty of water are recommended.
3. Regional Slimming What are the points to be taken into consideration beforehand?
Please answer the following questions completely.
1. Do you have any infection in the application area or in your body? YES NO
2. Do you have a chronic disease such as diabetes? YES NO
3. Do you have an allergy, immune system or rheumatic disease? YES NO
4. Have you had any surgery? YES NO
5. Do you have an active skin disease or do you have herpes attacks? YES NO
6. Are you prone to bleeding? YES NO
7. Are you positive for hepatitis (HBsAG, HCV) or AIDS (HIV)? YES NO
8. Are you at risk of pregnancy, pregnancy or breastfeeding? YES NO
9. QHave you used any medication in the past 1 week? YES NO
10. Have you used blood thinners (aspirin, coumadin, etc.) in the last 3 days? YES NO
11th. Have you had any dermatological or aesthetic procedures in the last month? YES NO
12. Have you tanned with the sun or a tanning bed in the last few weeks? YES NO
13. If you have had this procedure done before, have there been any problems? YES NO
WRITE BELOW THE SITUATIONS WHEN YOU ANSWERED YES TO THE QUESTIONS OR WOULD YOU WANT TO EXPLAIN OTHER THAN THE QUESTIONS.
4. Regional Slimming How is it applied and what is the course of its effect?
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You will experience a feeling of heat during regional thinning, especially in some sensitive areas, more heat may be felt. If it becomes too disturbing, you need to report it.
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Ringing in the ear may be felt during the application of sound waves. This procedure is not suitable for those who have hearing problems.
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During regional slimming application, the diameter of the application area is measured with a tape measure in three places. When the process is completed, it is measured again with a tape measure in the same places. There will be a decrease in measurements after each session. While this decrease is greater in places and people with high fat mass, it is less in places and people with low fat mass. Therefore, thinning varies from person to person and region to region.
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It is possible to get rid of most of the excess fat if regional slimming sessions are continued regularly.
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Regional slimming success may be low due to chronic diseases due to various reasons, hormonal diseases, some drug use or due to unknown conditions. In addition, although good success has been achieved after regional slimming, subsequent situations may cause fatness again.
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Session intervals should be approximately 7 days. After each session, you may be told when to come and we can also arrange your sessions according to you.
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The number of sessions cannot be given for a successful regional slimming application; many consecutive sessions may be required. These values are average times and may vary depending on the person.
5. Regional Slimming What are the points to be taken into consideration after?
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After the application, it is necessary to drink plenty of water and, if possible, a diet is recommended.
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If an unexpected effect develops, please contact our center.
6. Regional Slimming What are the Risks and Side Effects of its Application?
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As with all transactions, there are some risks in this transaction.
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In the application area
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Redness (erythema)
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uLocal swelling in the application area
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crusting
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Burns may occur.
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Darkening or lightening of the skin color may occur in the application area.
The side effects mentioned above are unlikely to occur. These side effects generally occur as a result of not adjusting energy levels well. Besides, they are not permanent.
APPROVAL OF THE PERSON TO BE TRADED
This procedure is not of vital importance like other cosmetic applications.is. Cosmetic procedures are non-medical performed to reduce the negative effects on your skin such as wrinkles, lines, spots, scars, tattoos, capillaries, hair loss, sagging, stretch marks, unwanted hair, lack of moisture or unpleasant facial and body appearances.interventionare ales. For reasons that are not fully understood, the success and permanence of the procedure may be shorter than expected. Additionally, no guarantee can be given regarding the results of the application. Any side effects that may occur will be evaluated by our center and improvement procedures (prescription adjustment, medical intervention, emergency intervention) will be carried out by our center's contracted doctor in the doctor's office. You can reach us at any time through the communication channels provided to you by our center.
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I was explained and understood that no cosmetic intervention, medical intervention or treatment could be performed on me without my permission.
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REGIONAL THINNING Above I have read the text containing the information that must be given before the application. I understand the expected impact and risks of the method to be applied.
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In addition, other application options, possible consequences and risks were explained to me, written and verbal explanations were made to me about this procedure, necessary warnings were given and I understood it.
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I was in a position to ask questions about the trading options to be applied and their risks. My questions and concerns were discussed and answered to my satisfaction.
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It was stated to me that visual material samples (such as photographs) could be taken before, during and after the procedure in order to evaluate the effectiveness of the procedure to be performed, and I agreed.
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I understand that no guarantee is given as a result of the procedure to be performed on me.
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I did not encounter any coercive behavior in purchasing this application.
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Under these conditions, I voluntarily agree to have a REGIONAL THINNING performed and to pay the necessary cost for this application.
THE PERSON TO whom the APPLICATION IS MADE
Name and surname:
History:
Signature:
THE PERSON WHO MAKES THE APPLICATION
Name and surname:
History:
Signature:
THE PERSON WHO WITNESSED THE APPLICATION
Name and surname:
History:
Signature: