VIORA- REACTION CONSENT - Facial Techniques 2026

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The document is a consent form for the VIORA Reaction treatment, which aims to improve the appearance of cellulite and skin texture through radio frequency technology. It outlines expected results, individual variability in response, the need for maintenance treatments, and potential side effects. The patient acknowledges understanding the treatment's limitations and consents to being photographed for educational purposes.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your Patient Name and Date of Birth (DOB) in the designated fields at the top of the form.
Review the information regarding treatment expectations, including potential improvements and necessary maintenance sessions. This section is crucial for understanding what to expect from the procedure.
Carefully read through the side effects and complications listed. Acknowledge these by considering your medical history and any sensitivities you may have.
In the consent section, confirm your understanding of the treatment's variability and your responsibility for outcomes by signing and dating where indicated.
Lastly, provide a witness signature along with their date to finalize your consent.

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