CLIENT DETAILS

Address

MEDICAL HISTORY

Medical History

AESTHETIC HISTORY

Previous Aesthetic Treatments

CLIENT CONCERNS

Client Concerns

PRACTITIONER ASSESSMENT

Fitzpatrick Skin Type

XERF Information

XERF is a non-invasive skin tightening and rejuvenation treatment using advanced monopolar radiofrequency technology.

Controlled radiofrequency energy heats different depths of the tissue, helping stimulate collagen remodelling and improve the appearance of skin laxity, firmness and overall skin quality.

Results develop progressively and vary between individuals. Multiple treatments and maintenance treatments may be recommended.

EXPECTED RESULTS & LIMITATIONS

Expected Results & Limitations(Required)

RISKS & POSSIBLE SIDE EFFECTS

Risks & Possible Side Effects Acknowledged(Required)

Contraindications & Precautions

XERF treatment may not be appropriate where certain medical conditions, devices, implants or recent procedures are present.

I understand that some conditions listed above may require treatment to be postponed, modified or medically cleared rather than representing an absolute contraindication in every case.

I agree to disclose all relevant medical conditions, medications, implants and previous cosmetic procedures to my practitioner before treatment.

PHOTOGRAPHY, VIDEO & MARKETING CONSENT

Photography & Marketing Consent(Required)
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PRIVACY POLICY

Privacy Policy Consent(Required)

Privacy Policy

Clinical records and photographs may be retained in accordance with Australian law and applicable insurer requirements.

Information will only be disclosed where legally required or with consent.

FINANCIAL, REFUND & CANCELLATION POLICY

Financial, Refund & Cancellation Policy

Completed treatments are non-refundable except where required by Australian Consumer Law.

Late cancellations, no-shows and insufficient notice may result in fees or loss of deposit in accordance with the clinic's cancellation policy.

Unused package sessions are non-transferable unless approved by management, subject to rights that cannot be excluded under Australian Consumer Law.

COMPLAINTS POLICY

Complaints Policy

Clients should contact the clinic promptly regarding any concerns following treatment.

Complaints Policy Agreement(Required)

This treatment is cosmetic and is not intended to diagnose, treat, cure or prevent disease.

No verbal or written statement constitutes a guarantee of outcome.

Nothing in this agreement excludes any rights that cannot be excluded under Australian Consumer Law.

The practitioner reserves the right to refuse, postpone or modify treatment where treatment is considered unsuitable or unsafe.

I authorise the clinic to recommend or arrange medical review if an adverse event occurs and medical assessment is considered appropriate.

PATIENT DECLARATION

Patient Declaration(Required)

TREATMENT RECORD

Aftercare

Keep the treated area clean and use gentle skincare following treatment.

Apply SPF50+ daily and minimise unnecessary sun exposure.

Avoid excessive heat, including sauna, steam rooms and very hot showers, while the skin remains warm, red, swollen or sensitive.

Avoid strenuous exercise if the treated area remains noticeably warm or flushed.

Avoid aggressive exfoliation, strong active skincare or irritating products until the skin has settled.

Avoid additional RF, HIFU, laser, needling, peels or other intensive skin treatments until advised by your practitioner.

Maintain normal hydration.

Do not deliberately apply excessive heat or ice directly to the treated area unless instructed by your practitioner.

Contact Bayside Endermologie if you develop persistent or increasing pain, significant swelling, blistering, burns, signs of infection, unexpected skin changes or another reaction that concerns you.

Seek appropriate medical attention for any severe or rapidly worsening reaction.

SIGNATURES

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