VascuLyse

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VascuLyse

VascuLyse is a non-invasive device that uses electro coagulation (gentle current) to safely and instantly eliminate skin blemishes from almost anywhere on the body, in as little as 1 to 3 treatments. These skin blemishes include; Hyperpigmentation, Skin Tags, Ruby Points, Milia, Broken Blood Capillaries, Spider Veins, Cholesterol Deposits around the eyes and Sebaceous Hyperplasia.

Treatment using VascuLyse is safe and effective, with no scarring or down time. Finally be free of those unwanted skin blemishes for good!

Email *

Name *

Phone Number *

Address *

Area to be Treated: *

Blemish to be Treated: *

Please read and check the following boxes. Should you have additional questions please contact me before your scheduled appointment. *

The nature and purpose of the treatment has been explained to me, and any questions I have regarding this procedure has been answered to my satisfaction.

I do not have any of the following contraindications preventing me from having treatments with the Vasculyse 2G device: pacemaker, insulin dependency or severe diabetes, pregnancy, anticoagulant use (such as Warfarin or Coumadin), medical conditions that may affect blood coagulation, viral hepatitis, HIV, cancer, keloid scars, medical conditions or medications that delay the healing process

I understand, that with any treatment} certain risks are involved and that complications or side effects from known or unknown causes may occur. I freely assume these risks

Possible side effects may include mild redness, extreme redness, local swelling, bruising, tenderness, stinging, changes in skin colour, and infection. Most side effects are temporary and usually resolve within 7 to 21 days.

I have been advised not to touch or rub the treated area, not to pick scabs and to let them fall on their own. I understand that I must keep the area clean and use products that hydrate and soothe, avoid sun exposure and use total sunblock on the treated area until healing is complete

Treatment will be withheld if the client shows signs of cold sores, infectious acne, dermatitis or any other condition deemed unsafe by beauty care professionals. Treatment will resume once the esthetician decides that the condition is no longer a concern.

I have received a copy of the home care instructions.

I agree to comply with all safety precautions and home care instructions as recommended by my therapist or technician and will inform him/her of any concerns or complications should any occur

While satisfactory results are often achieved with one treatment, some cases may require more treatments

There is no way to guarantee that the desired result will reflect the end result. Your own body and biological response is a major factor in the final outcome.

I am over 18 years of age

I have read the preceding explanations, the instructions for the Vasculyse 2G} and understand the potential risks and benefits of the treatment

Required

By signing below and checking each above box, I'm confirming that I have read and understood the above statements and consent to receiving treatments with the Vasculyse 2G device. *

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Should you have any questions or concerns about whether or not your lesions are safe to be treated, please consult a physician.

Send me a copy of my responses.

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