Please type your name:

phone number:

I authorize BBL treatments to be performed on the following area(s) of my body:

I understand that the Sciton BBL is intended for benign vascular (or redness) and pigmented (browns) benign lesions, and/or permanent hair reduction, and/or sun damage and anti aging, collagen boosting, and/or acne reduction and that clinical results may vary in different skin types.  I understand that there is a possibility of rare side effects such as scarring and long term discoloration as well as short term effects such as reddening, mild burning or snap sensations, swelling, temporary bruising and discoloration of the skin.  I understand that any pigmented hair growth may be reduced in areas of treatment so appropriate planning is required each time.  A significant part of my result is up to me with good communication with my provider(s), recommended skincare, post treatment care and sun protection.  Best results are known to require additional treatment and or maintenance and my provider(s) have set reasonable expectations for results.  These things have been fully explained to me.

Based on the experience of other physicians we have found that those people who tend to sunburn rather than tan, usually obtain good results on the first and subsequent visits.  Those who tan more easily tend to have more variation in their results.  Some patients in this category will experience partial results and some will experience no obvious visible improvement initially however comparison of before and after photos are needed as our memories do not accurately reflect results.   These things have been fully explained to me.

Photography

I do consent to photographs and other audio-visual and graphic materials before, during, and after the course of my therapy to be used for medical, marketing, and education purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I may or may not be identified by the photos.

I do consent to allow the photographs to be used in presentations or publications including marketing, but not limited to, use by CB Skin Secrets to further education and inform others about BBL treatments.

I have read and understand all information presented to me before signing this consent form. I have been given an opportunity to have all of my questions answered to my satisfaction. I understand the procedure and accept the risks. By typing my name below I agree to the terms of this agreement.

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