BMS Facial Massage Consent Form

Ultraformer MPT Patient Consent Form

CLIENT DETAILS

Address

MEDICAL HISTORY

Medical History

CLIENT CONCERNS & GOALS

Treatment Goals

PRACTITIONER ASSESSMENT

Fitzpatrick Skin Type

BMS FACIAL MASSAGE INFORMATION

BMS Facial Massage uses biomechanical stimulation technology to stimulate facial muscles, support circulation, lymphatic drainage and facial rejuvenation. Results vary between individuals and multiple treatments may be recommended.

Expected Results & Limitations(Required)
Contraindications Acknowledged(Required)
Risks & Possible Side Effects Acknowledged(Required)

PHOTOGRAPHY, VIDEO & MARKETING CONSENT

Photography & Marketing Consent(Required)
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PRIVACY POLICY

Privacy Policy Consent(Required)

Clinical records and photographs may be retained according to Australian law and insurer requirements.

FINANCIAL, REFUND & CANCELLATION POLICY

Completed treatments are non-refundable except where required by Australian Consumer Law. Late cancellations and no-shows may result in fees or loss of deposit.

COMPLAINTS POLICY

Complaints Policy Agreement(Required)

This treatment is cosmetic/wellness based and not intended to diagnose, treat, cure or prevent disease. No verbal or written statement constitutes a guarantee of outcome. Nothing in this agreement excludes rights under Australian Consumer Law. The practitioner reserves the right to refuse or postpone treatment if unsuitable.

PATIENT DECLARATION

Patient Declaration(Required)

TREATMENT RECORD

Aftercare:

  • Drink water after treatment
  • Maintain normal skincare routine unless advised otherwise
  • Temporary tenderness may occur
  • Contact the clinic if unusual symptoms occur

FOLLOW-UP REVIEW

SIGNATURES

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