Medical Aesthetics Bar

Plasma IQ — Consultation, Consent & Care Form

Patient Information

Treatment Information

About Plasma IQ:

• Plasma IQ is a non-invasive plasma energy treatment designed to tighten skin, reduce fine lines and wrinkles, improve texture, and stimulate collagen production.

• Results vary depending on individual skin type, condition, and adherence to pre- and post-care instructions.

Pre-Treatment Instructions:

• Avoid tanning, sun exposure, or tanning products for 2 weeks prior.

• Avoid retinol, chemical peels, or exfoliating treatments for 3–5 days prior.

• Disclose all medications, supplements, medical conditions, implants, or previous surgeries.

• Cleanse treatment area thoroughly; do not apply makeup, creams, or oils on the day of treatment.

• Avoid blood-thinning medications unless cleared by your physician.

Post-Treatment Instructions:

• Mild redness, swelling, or scabbing is normal and usually resolves in 5–7 days.

• Avoid scratching, picking, or rubbing the treated area.

• Avoid sun exposure; use broad-spectrum SPF 30+ once healed.

• Do not apply harsh chemicals, retinol, or exfoliants for 7–10 days.

• Cleanse gently with a mild, fragrance-free cleanser; pat dry.

• Avoid hot showers, saunas, or intense workouts for 24–48 hours.

• Apply any recommended healing creams as instructed.

• Multiple sessions may be recommended; attend follow-up for optimal results.

Consent & Liability Acknowledgment

I, the undersigned, acknowledge and agree that:

1. I am voluntarily receiving Plasma IQ treatment at Medical Aesthetics Bar, and I fully understand the nature, purpose, and potential risks of the procedure.

2. I have provided complete and accurate medical history including allergies, medications, implants, previous surgeries, and history of cancer.

3. I understand that results vary and no guarantees or warranties are made regarding the outcome of the treatment.

4. I have read, understood, and agree to follow all pre- and post-treatment instructions.

5. I release, indemnify, and hold harmless Medical Aesthetics Bar, its owners, employees, and contractors from any liability, claims, or damages arising from the treatment, except in cases of gross negligence or willful misconduct.

6. Photographs may be taken for documentation, treatment comparison, or educational purposes, and I consent to their use while maintaining confidentiality unless otherwise authorized.

7. I understand that if I experience any unexpected effects or complications, I will contact Medical Aesthetics Bar immediately for evaluation.