CLIENT DETAILS

MEDICAL HISTORY & HEALTH SCREENING

Medical History

SKIN ASSESSMENT

Fitzpatrick Type
Skin Type

About Cold Plasma

Cold Plasma is a non-invasive treatment that uses ionised gas energy to support skin rejuvenation, healing, inflammation reduction, acne management, rosacea support, wound healing and enhanced absorption of skincare products.

Multiple sessions may be required. Results vary between individuals and cannot be guaranteed.

Contraindications

Treatment may not be suitable for clients with active infection, uncontrolled medical conditions, severe skin disease, active cancer treatment, recent isotretinoin use or other conditions identified by the practitioner.

Risks & Possible Side Effects

  • Temporary redness
  • Warmth or tingling
  • Mild swelling
  • Dryness or flaking
  • Temporary sensitivity
  • Temporary breakouts
  • Hyperpigmentation or hypopigmentation (rare)
  • Infection (rare)
  • Delayed healing (rare)
  • Allergic reaction to products (rare)

No guarantee of specific results has been given.

PRE-TREATMENT ACKNOWLEDGEMENT

Pre-Treatment Acknowledgement(Required)

Aftercare Instructions

First 24 Hours:

  • Avoid sauna, steam rooms, spas and swimming.
  • Avoid excessive exercise and sweating.

For 3–5 Days:

  • Avoid retinol, exfoliants, AHAs, BHAs and aggressive skincare.
  • Avoid unnecessary heat exposure.

Daily:

  • Apply SPF 50+.
  • Keep skin hydrated.
  • Follow practitioner recommendations.

Contact the clinic immediately if unexpected reactions occur.

PHOTOGRAPHY & VIDEO CONSENT

Photography & Video Consent(Required)

I understand clinical photographs may be required for treatment records.

PRIVACY CONSENT

I consent to Bayside Endermologie collecting, storing and using my personal and health information for consultation, treatment, administration, insurance, legal compliance and communication purposes in accordance with the Australian Privacy Principles.

Privacy Consent(Required)

PAYMENT, CANCELLATION & REFUND POLICY

  • Payment is due on the day of treatment unless otherwise agreed.
  • Deposits are non-refundable.
  • 24 hours notice is required for cancellations or rescheduling.
  • Missed appointments and late cancellations may result in forfeiture of deposit.
  • Due to the nature of aesthetic treatments, completed treatments are non-refundable.
  • Results vary between individuals and cannot be guaranteed.
  • Nothing in this agreement excludes your rights under Australian Consumer Law.

COMPLAINTS POLICY

Bayside Endermologie is committed to providing safe and professional services.

If you have concerns regarding your treatment, please contact the clinic as soon as possible. Complaints will be reviewed promptly and handled fairly. This policy does not limit your rights under Australian Consumer Law.

CLIENT DECLARATION & INFORMED CONSENT

Client Declaration(Required)

TREATMENT RECORD

SIGNATURES

Clear Signature
Clear Signature