TR BEAUTY SPA Official Page

Client Information

Full Name

Phone Number

Date of Birth

Technician

Date of Treatment

Treatment Description

Mesotherapy is a non-surgical cosmetic treatment involving microinjections of vitamins, enzymes, hormones, and plant extracts into the skin to rejuvenate, hydrate, brighten, and treat specific conditions like acne or dark circles. Depending on the indication, multiple sessions may be recommended.

Treatment Selection

Please select the treatment type:

HA (Hyaluronic Acid) - Hydrates and improves skin elasticity

HA + DNA - Boosts collagen, brightens, repairs skin

Brightening Injection - Reduces pigmentation and evens skin tone

Acne Injection - Reduces inflammation and speeds healing

Eye Contour - Targets wrinkles and hydrates eye area

B.A.P Injection (Bio Aesthetic Points) - Lifting, firming, brightening

Medical History

Do you currently have or have had any of the following?

Allergies to medications or injectables

Autoimmune disorders

Diabetes

Blood clotting disorders

Heart or liver disease

Pregnant/Breastfeeding

Use of blood thinners

Active skin infections

If any are checked, please describe

Risks & Side Effects

I understand that while Mesotherapy is generally safe, possible side effects include:

Swelling, redness, or bruising at injection sites
Itching or tenderness
Infection or allergic reaction (rare)
Temporary skin discoloration or sensitivity

Client Responsibilities & Aftercare

Avoid touching or massaging treated areas for 24 hours
Refrain from intense exercise, alcohol, or saunas for 24-48 hours
Apply cold compress if swelling occurs
Follow all aftercare instructions provided by your technician

Photo/Media Consent

I give TR BEAUTY SPA permission to take photos/videos of my treatment area for:

Internal records only

Marketing and educational purposes (social media, website, etc.)

I do NOT consent to any photography

Consent & Release

I confirm that all provided information is accurate.
I understand the nature, risks, and benefits of Mesotherapy treatment.
I release TR BEAUTY SPA and staff from liability for any adverse outcomes if aftercare is not followed or health conditions were undisclosed.
I understand that results may vary and no guarantees are made.

I understand that TR• Beauty Spa is committed to providing safe, professional, and individualized treatments using appropriate techniques and medical-grade technologies. I acknowledge that treatment outcomes vary between individuals and depend on factors beyond the control of TR• Beauty Spa, including my skin condition, medical history, lifestyle, healing response, and compliance with aftercare instructions. Therefore, no specific result or degree of improvement can be guaranteed. I understand that an outcome different from my expectations does not, by itself, indicate negligence or improper treatment. All treatments and packages are Final Sale and non-refundable, except where required by applicable law.

By signing below, I confirm that I have read and understood the information provided, and I willingly consent to undergo the specified Mesotherapy treatment at TR.beautyspa.

Client Signature

Please sign in the box below

Date

Mesotherapy Treatment

CLIENT INTAKE FORM