» Mesotherapy Treatment Consent Form

Mesotherapy Treatment

CLIENT INTAKE FORM

Client Information

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:

Medical History

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

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:

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.

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
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