Laser Vaginal Rejuvenation

Universal Laser Center
The Rejuvenation Center of Miami

Consent for vaginal laser treatment provides the client’s authorization to perform vaginal laser rejuvenation by Universal Laser Center. The Informed Consent is required for any treatment we provide and in this documents clients receive an explanation of the treatment

Universal Laser Center is The Rejuvenation Center of Miam a place where advanced laser technology is seamlessly integrated with various aesthetic treatments to help our clients look younger and feel content with their appe

Consent for Vaginal laser treatment

The Consent for Vaginal Laser Treatment is a document where you give authorization to our professional to proceed with the vaginal laser treatment knowing how the treatment is performed and receive an explanation of all your questions about the treatment and results.

Informed Consent For Treatment for Vaginal Health with the Phoenix CO2 Laser System

I, ___________________________________, authorize and consent to the treatment for vaginal health with the Phoenix CO2 Laser.

I have been advised by, _____________________________________________ of

_________________________________________ of the purported advantages and disadvantages associated with this treatment.

I understand that treatment with this laser system varies from patient to patient and that that more that 1-treatment may be required.

No guarantees have been made to me regarding the outcome of the treatment or any improvements in my condition due to the procedure._________ (initials)

I understand that the possible benefits are the reduction of pain during intercourse, reduction of itchiness in the vaginal area and increased lubrication in the vaginal area (vaginal health). _________ (initials)

Due to the brilliance of the laser light energy used, I agree to wear eye protection to shield my eyes. ________ (initials)

I have been given the opportunity to ask questions and have received satisfactory answers to these questions.________ (initials)

I hereby authorize the taking of photographs. These photographs may be used to demonstrate the results this laser produces. ________ (initials)

I hereby indemnify and hold harmless Rohrer Aesthetics, Inc. and their employees, the treating technician and ____________________________________ from any and all liability, damages, cost and expenses arising from or out of the use Phoenix-CO2 Laser for the vaginal health treatment.. _______ (initials)

With all of the above information understood, I am choosing to be treated with the Phoenix CO2 Laser.

___________________________________ Signature

____________________________________ Print Name

____________________________________ Date

____________________________________ Witness

Consent for Vaginal laser Treatment.Woman is waiting for a medical examination in gynecological cabinet
Consent for vaginal Laser Treatment. Gynecologist prepares patient for examination using vaginal ultrasound device