Form Stretch Mark Restoration | IVY Wellness Center & Spa

Stretch Mark Restoration Form

Full Name

Appointment date

Age

Profession

Whatsapp number

1. Are you pregnant? Yes / No *Pregnant women cannot undergo this treatment until after pregnancy

2. Do you have any condition that prevents you from getting tattoos?

3. Do you have any skin diseases or allergies?

4. Have you had any other procedures or surgeries in the treated area?

Informed Consent

1. I understand and am satisfied with the information provided to me regarding the treatment and authorize IVY Wellness Spa and the therapist to perform the Stretch Mark Restoration treatment on the indicated area.

2. I promise that I do not have any contraindications that would prevent me from undergoing the procedure, such as pregnancy, melanoma, or any contraindication to getting a tattoo.

3. I give permission for photographs to be taken of me before, during, and after the procedure, for use as evidence of my treated area, without mentioning my name or including photos of my face. I authorize the use of these photos for marketing purposes.

4. I understand that the main objective of the therapy is to improve the skin through the application and penetration of active agents via microneedling, and I understand that the Restoration procedure is not a permanent cure, but it can help improve the treated area.

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