top of page

Client Consent Form - HIFU Face


Laser Lipo

Client Safety 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 active infections?
Do you suffer from dermatitis or eczema within the treated area?
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?
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?

CLINIC ADDRESS

Your treatment is up at Suite 603, Level 6, Harley Place, 251 Oxford Street, Bondi Junction (diagonally opposite Zara exit of Westfields).  When you arrive, please take a seat in reception and your treatment specialist will be out at your confirmed appointment time.

​​

Note: If you are driving, please allow more than adequate time for traffic and parking.  There is 2hrs free parking opposite in Westfields Mall.

Harley.jpg

Thanks for submitting!

bottom of page