Client Consent Form - HIFU Face

HIFU Face - Client Consent Form

Please read carefully and fill out the following form to help us understand your suitability for treatment

Are you experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell?
Have you travelled internationally within the last 14 days?
Have you or any of your household members been diagnosed with COVID-19 WITHIN THE PAST 30 DAYS?
Are you pregnant, breast feeding, or trying to conceive?
Do you have any current or previous skin cancer (epithelioma and melanoma) or any benign/malignant tumors?
Do you have impaired motor functions (paralysis of facial muscles), presence of metallic materials or gold implants in bone/tissue in area that is being treated, or any infectious skin disease?
Are you suffering from eczema in area of treatment?
Do you suffer from diabetes or epilepsy?
Do you have a pacemaker?
Do you have have any pre-existing medical conditions or have any questions regarding your treatment, if so please contact Advanced Face and Body prior to your treatment to discuss your suitability for treatment?
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CLINIC ADDRESS

Your treatment is at 116 Spring St, Bondi Junction (note: there is close parking in Westfields Mall or Eastgate Shopping Centre)

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Thanks for submitting!