Procedures Consent Form

TRADE SHOW PROCEDURES CONSENT FORM
for ClearFX and ThermoClear Machines

I am over the age of 18, am not under the influence of drugs or alcohol and consent to be a model at the Trade show for the purpose of learning more about the ThermoClear RF (radio frequency) machine.

The general nature of the procedure has been explained to me and I have signed and understand the consent form for this procedure. The ThermoCLEAR machine treats unwanted epidermal skin imperfections such as: white heads, sebaceous hyperplasia, skin tags, sun spots, superficial capillaries and hair removal.

I have discussed pre and post procedure instructions and I will strictly adhere to such instructions as I understand they are crucial for healing.The skin treated may be red and swollen with fine, thin scabs.Keep the treated areas covered with Caladryl, Polysporin and/or Bacitracin until the thin scabs fall off.This process can take anywhere from 1-3 weeks to heal completely.It could take as long as 1-3 months in some rare cases.Do not scratch the scabs, as that can cause scarring and prolong the healing time.

By completing and submitting the form below, you certify you have read the above paragraphs and have had explained to your full understanding this consent and procedure permit and I will not hold ThermoClear USA, ClearFX, or their designated professionals responsible for any unforeseen condition arising out of the indicated procedure.