Fat Dissolving - Consent Form

 Marketing

We would like to contact you with special offers, related products and relevant services. If you consent for this purpose, tick you preference:

Photographs taken shall be part of the medical record and used for documentation of response to treatment. With explicit permission these photographs may also be used for educational purposes or for client information.

As part of the marketing activity (digital and/or print) we would like to use anonymously before & after photos of your treatment for use to promote this treatment.

Introduction to Lemon Bottle.

I confirm I have seen aesthetic practitioner for a medical health check prior to today's treatment.

THE TREATMENT

Fat Dissolving Injections: 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.

BENEFITS: 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.

RISKS AND COMPLICATIONS: 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. - In rare instances, more serious complications may arise.

I hereby indemnify the aesthetic practitioner from any liability relating to the procedures that I am having. I also understand that any treatment performed is between me and the practitioner who is treating me and I will direct all post-operative questions or concerns to the practitioner.

The possible side effects of Lemon Bottle include but are not limited to:

BLEEDING & BRUISING: It is possible, though unusual, to have a bleeding episode from a Fat Dissolving injection during the procedure. Bruising in soft tissues may occur. Should you develop post-injection bleeding, it may require emergency treatment or surgery. Aspirin, anti-inflammatory medications, platelet inhibitors, anticoagulants, Vitamin E, ginkgo biloba and other "herbs / homeopathic remedies" may contribute to a greater risk of a bleeding problem. It is recommended not to take any of these for seven days before or after Fat Dissolving injections.

SWELLING: Swelling (oedema) is a normal occurrence following the injections. It decreases after a few days. If swelling is slow to resolve, medical treatment may be necessary.

ERYTHEMA (Skin Redness): Erythema in the skin occurs after injections. It can be present for a few days after the procedure.

NEEDLE MARKS: Visible needle marks from the injections occur normally and resolve in a few days.

ACNE-LIKE SKIN ERUPTIONS: Acneiform skin eruptions can occur following the injection of tissue fillers. This generally resolves within a few days.

VISIBLE TISSUE MATERIAL: It may be possible to see any type of tissue product material that was injected in areas where the skin is thin.

PAIN: Discomfort associated with Fat Dissolving injections is normal and usually of short duration.

SKIN SENSITIVITY: Skin rash, itching, tenderness and swelling may occur following Fat Dissolving injections. After treatment, you should minimise exposure of the treated area to excessive sun or UV lamp exposure and extreme cold weather until any initial swelling or redness has gone away. If you are considering laser treatment, chemical skin peeling or any other procedure based on a skin response after Fat Dissolving treatment, or you have recently had such treatments and the skin has not healed completely, there is a possible risk of an inflammatory reaction at the implant site.

RESULTS

Results from Lemon Bottle fat-dissolving injections are typically gradual and may require multiple sessions for optimal outcomes. On average, individuals may need three to six treatment sessions, spaced at appropriate intervals, depending on the targeted areas and the amount of fat reduction desired. It is important to note that individual results may vary based on factors such as metabolism, lifestyle, and adherence to the advised post-treatment care instructions. I have been informed that following the recommended aftercare, including maintaining a healthy and balanced lifestyle, plays a significant role in achieving and sustaining the best possible results. By proceeding with this treatment, I consent to following the outlined recommendations and understand that the results may develop progressively over time.

Follow-Up and Additional Sessions

• The client will be scheduled for follow-up appointments to assess progress and determine the need for additional sessions.

• Most patients require three to six sessions for optimal results, spaced 4–6 weeks apart. The exact number will depend on the individual patient and the amount of fat reduction desired.

• During follow-ups, the practitioner will evaluate the results and make any necessary adjustments to the treatment plan.

  
  

This protocol ensures the safety, effectiveness, and satisfaction of patients undergoing Lemon Bottle fat-dissolving injections. All steps are designed to prioritise the patient's wellbeing while supporting their aesthetic goals.

MEDICAL HISTORY & CURRENT MEDICAL CONDITIONS 

Please check any health conditions which you have ever had previously or are now experiencing. (If Yes to any of the following please detail in the box below)

Current Medical Status

By signing below l acknowledge that I have read the foregoing informed consent and agree to the treatment with its associated risks.

I understand this is an elective procedure & the procedure has been fully explained to me. I have read the above and understand it. My questions have been answered satisfactorily. I accept the risks and complications of the procedure and I understand that no guarantees are implied as to the outcome of the procedure. I also certify that if I have any changes in my medical history I will notify the professional who treated me immediately. I also state that I read and write in English.

I certify by signing this form that you have read the information in this document and completely understand it. I choose to proceed based entirely on the information provided in this informed consent document. You have been given all the necessary opportunities for discussion and all your questions regarding Fat Dissolving injections have been answered. I therefore and hereby consent to the care or treatment described herein.

PRACTITIONER ONLY

I confirm that I have fully informed the patient about the risks and benefits of treatment with Fat Dissolving and believe they understand all the information given.

They have also been informed of alternative treatment for their presenting complaint.