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Please complete this consent form before your Skin Boosters (Profhilo, Seventy Hyal, Lumi Eyes) appointment. Once you sign, a copy is emailed to you and to Gemma automatically.

Your details

Skin Boosters (Profhilo, Seventy Hyal, Lumi Eyes) — treatment information & disclaimer

Skin boosters are injectable treatments (including Profhilo, Seventy Hyal 2000 and Lumi Eyes) that deliver hyaluronic acid and bio-remodelling ingredients into the skin to hydrate, improve quality and stimulate the skin's own collagen and elastin. They are administered by intradermal injection using fine needles. More than one session is usually needed, and results and their duration vary between individuals with no guarantee of a specific outcome.

Common risks include pain, redness, swelling, tenderness and bruising at the injection sites, which usually settle within a few days but can last up to two weeks. Uncommon risks include infection (cellulitis/abscess), reactivation of cold sores, and delayed inflammatory nodules (granuloma).

Rare risks include allergic/anaphylactic reaction requiring emergency care, and vascular occlusion (injection into a blood vessel) which, if untreated, can lead to tissue damage (necrosis). Your practitioner is trained to manage this, including with hyaluronidase where appropriate; in rare cases urgent specialist medical assessment may be required.

A non-refundable deposit is required to secure your appointment. The balance is payable at your appointment. Deposits and booking fees are non-refundable unless agreed with the practitioner.

Medical screening

Please answer honestly — this keeps your treatment safe. Add detail in the notes where relevant.

1. Are you pregnant, breastfeeding, or trying to get pregnant?
2. Do you have any medical conditions? If yes, please give details.
3. Are you taking any medication (including blood thinners such as Warfarin/Aspirin)? If yes, please list.
4. Do you have any allergies, or have you ever had anaphylaxis? If yes, please give details.
5. Do you have any skin or neuromuscular disorders?
6. Do you have diabetes, an autoimmune disease, or a bleeding/clotting disorder?
7. Do you have a history of keloid or hypertrophic (raised) scarring?
8. Do you have any active infection, cold sores, or inflammation at the treatment area?
9. Have you had this or a similar treatment before? If so, did you have any problems?
10. What are your aims and motivations for the treatment / desired outcome? Please give details.
11. Is there any other medical or social history we should know? Please give full details.
12. Do you understand the information provided and feel it is sufficient for you to consent?
13. Has your consent been given freely?

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