Informed Consent Hydrolipoclasia

It is a treatment that helps eliminate localized fat safely.

The patient is previously informed about the procedure in detail.
And with this you will be satisfied with each of the steps that will be
carried out on the day of the treatment and these are:
1 -The infiltration is carried out through a 20ml ml syringe with a N#21 needle, the
needles are removed, the alcohol is applied to clean the treated area and continue
with the next one.

2 - Ultrasound (cavitation) is applied using a conductive gel in the marked area and
the frequency of three (3) MHz is activated with maximum power and continuously.
The ultrasound application procedure lasts approximately 5 to 8 minutes per area.
It should be noted that the patient with prior evaluation, through a clinical record,
indicates that he does not have the following:
1. She is not pregnant
2. You are not breastfeeding
3. Does not have diabetes
4. Doesn't have a pacemaker
5. Does not have biopolymers
6. Does not have cardiac arrhythmia
7. Does not take anticoagulants
8. You are not allergic to any infiltrated vials that will be placed on you

The patient is also responsible for coming 3 days after the treatment for
lymphatic drainage and putting on a girdle to be able to achieve body
shaping. The patient also agrees that they will be told how many
treatment sessions they need and to drink at least 3 liters of water. for
the next 48 hours. It was also mentioned that there could be small
bruises.
Being so; I access and authorize to follow pre- and post-treatment
photographic control or other audiovisual and graphic materials
and with the sole purpose of evolutionary control of my treatment and
scientific evaluation.
Considering that I have been sufficiently informed and clarified my
possible doubts about the procedure and
possible results.
IT IS IMPORTANT THAT YOU READ THE INFORMATION CAREFULLY AND
HAVE ALL BEEN ANSWERED
YOUR QUESTIONS BEFORE YOU SIGN THE CONSENT.

Name and Signature of the patient

Name and signature of person responsible