RF SCULPT CONSENT FORM

PATIENT INFORMATION:

First Name

Last Name

Date Of Birth

Phone/Mobile

City

Next Of Kin

Kins Contact Number (Phone/Mobile)

MEDICAL HISTORY

Do you have any implanted medical devices (e.g., pacemaker, metal implants, or electronic devices) in or near the treatment area?

Yes

If Yes, please specify:

Do you have any conditions that affect heat sensitivity or circulation (e.g., diabetes, nerve disorders, poor circulation)?

Yes

If Yes, please specify:

Do you have any skin conditions or concerns in the treatment area (e.g., infections, inflammation, eczema, open wounds)?

Yes

If Yes, please specify:

Have you had any recent surgery or medical procedures in the treatment area (within the last 6–12 months)?

Yes

If Yes, please specify:

Are you currently pregnant, trying to conceive, or breastfeeding?

Yes

If Yes, please specify:

Do you have any other medical conditions?

Yes

If Yes, please specify:

Procedure Description:

I understand that I am receiving a radiofrequency (RF) body contouring treatment (Sculpt RF), which is a non-invasive procedure designed to improve skin tightness, reduce the appearance of fat, and enhance overall body contour.

Sculpt RF uses controlled radiofrequency energy to safely heat the deeper layers of the skin and underlying tissue. This process is intended to stimulate collagen production, improve skin elasticity, enhance circulation, and promote the natural breakdown of fat cells.

During the procedure, a handheld device will be applied to the targeted areas of the body. The treatment delivers consistent heat to the skin while maintaining surface comfort through built-in cooling or monitoring systems. This may help tighten the skin and improve the appearance of areas affected by laxity or uneven texture.

The treatment is generally comfortable and may produce sensations of warmth, heat, or a mild tingling feeling in the treated area. The intensity may vary depending on the treatment area and individual sensitivity.

I understand that multiple sessions may be required to achieve optimal results, and that outcomes vary depending on individual body composition, lifestyle, and treatment goals.

Benefits and Risks

I have been informed that the potential benefits of Sculpt RF (radiofrequency body contouring) treatment may include:

Improved skin tightness and elasticity
Stimulation of collagen and elastin production
Reduction in the appearance of localized fat
Smoother, firmer, and more contoured skin
Improved circulation in the treated area
Reduction in the appearance of cellulite
Non-invasive body sculpting with minimal downtime

I understand that there are potential risks and side effects associated with this treatment, including:

Sensations of heat, warmth, or tingling during the procedure
Temporary redness or swelling in the treated area
Mild skin sensitivity or tenderness after treatment
Uneven results or the need for additional sessions

I understand that serious complications are uncommon but may occur in rare cases.

Aftercare:

I agree to follow the post-treatment instructions provided by the clinician to ensure the best possible results and minimize any risks. I understand that failure to adhere to these instructions may increase the likelihood of complications.

Consent for Treatment:

I hereby consent to undergo an RF Sculpt treatment. I acknowledge that the clinician has explained the procedure, its benefits, and potential risks to me. I have had the opportunity to ask questions, and all of my concerns have been addressed to my satisfaction. I understand that the results of an RF Sculpt treatment can vary, and multiple sessions may be required for optimal results.

Release of Liability:

I release The Abram, its employees, and representatives from any liability associated with the RF Sculpt treatment, except for cases of negligence or intentional misconduct.

Human Error Acknowledgment:

I understand that aesthetic treatments are performed by qualified clinicians using professional equipment and established protocols. However, I acknowledge that, as with any procedure involving human involvement, there is a possibility of unintended outcomes due to human or technical error. By signing this consent, I accept this inherent possibility and agree that The Abram and its staff shall not be held liable for minor or unintentional errors occurring during the course of treatment, provided that reasonable care and professional standards are followed.

Photographs and records:

I understand that videos and photos will be taken for medical documentation purposes and will be used only for treatment comparisons and tracking progress milestones.

Client's Initial

Receptionist's Initial

Technician's Initial

I agree that all the above information is true and accurate to the best of my knowledge

Client’s signature: