We are 100% committed to the health and well-being for everyone. We are doing everything we can to keep potential exposure out of our office.

As part of the local and state guidelines you must answer no to all the following questions each time you enter Pua Manu Medspa.

• Not present a fever over 100 F/ 37 C.
• Not presenting cold, cough, difficulty breathing muscle pain, headache,
  loss of taste/smell or pink eye in past 14 days.
• Not in contact with anyone with these symptoms in the past 14 days.
• Not currently under quarantine order or directive.
• Not in contact with anyone diagnosed with COVID-19, sick and quarantined, in the past 14 days.

All information above is true. I may be asked again when I arrive for my appointment. 
ALL PATIENTS AND STAFF ARE REQUIRED TO: 

• Please follow our local and state regulations and guidelines, including those related to occupancy levels, social distancing and other measures intended to reduce the spread of viruses.
• Stay home if you are sick or are exhibiting symptoms of illness such as a fever or persistent cough.
• Face mask are required to enter the Spa.
• Refrain from shaking hands or other touching rituals.
• Wash hands for 60 seconds with soap and warm water prior to treatment or use hand sanitizer.
• Refrain from eating or drinking while in the Spa, face mask should not be removed. 

I agree to comply to the rules listed above.

 

I also understand that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. I further understand that COVID-19 is extremely contagious and is believed to spread by person-to-person contact, and as a result, federal and state health agencies recommend social distancing. I understand that Pua Manu Medspa has put in place reasonable safety measures to help reduce the spread of COVID-19.

I understand that COVID-19 may cause additional risks, some of which may not be known at this time.

I understand that I am consenting to an elective treatment/procedure that is not urgent or emergent. I understand that it may put me at increased risk for becoming infected with COVID-19, due to potential community exposure.

PATIENT’S ACCEPTANCE OF RISKS

By signing this consent form I accept the risks described above and give my permission to proceed with the treatment/procedure.

I have read this consent or someone has read it to me and want to proceed.

SkinTyte™ utilizes infrared energy to deeply heat soft tissue while protecting the entire treated area with sapphire contact cooling. Targeted heating causes soft tissue coagulation that tightens tissue as it heals, stimulating collagen contraction and remodeling. This process initiates the body’s natural healing process and a new foundation of collagen is created, resulting in a firmer, more youthful skin appearance. The full effect of skin firming treatments can be seen over several subsequent months.

I understand that short term effects such as reddening, mild burning, temporary bruising, temporary discoloration and in rare cases blistering of the skin may occur. Though rare, there is a possibility of side effects such as scarring and permanent discoloration. These effects have all been fully explained to me. I understand that lasers can cause eye injury and protective eyewear must be worn during treatment.

Before and after treatment instructions have been given to and discussed with me. The procedure as well as alternative treatment, potential benefits and risks have been explained and I have had all my questions answered to my satisfaction. I will not hold Dr. Chen, Lisa Morawitz or this practice responsible or liable for any non-compliance on my part or for any damages incurred otherwise.

I understand that SkinTyte™ is an elective procedure, that insurance does not cover this procedure and that I am solely responsible for payment. Fee structure and payment have been fully explained to me. I will be charged the full amount quoted. I will be asked to pay this amount in full prior to the procedure.

Discounted or special priced treatments must be prepaid in full by first treatment appointment. Incomplete and/or cancelled treatments will be charged at regular/full price, NO refunds.

I understand that necessary photos will be taken before, during and after the course of my treatments for medical purposes and to evaluate treatment effectiveness. I understand that my photos will be kept confidential in my electronic patient record.

I consent to photographs and other audio-visual and graphic materials before, during and after the course of my treatments to be used for marketing and medical educational purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I may or may not be identified by the photos.

By signing below, I certify that I have read and fully understood the contents of this consent form, and that the information I provided above are complete, accurate, and up-to-date to my knowledge. I acknowledge that I have read and understand all information presented to me before signing this consent form. I have consulted with the Esthetician prior to treatment and understand the treatment procedure and risks. I have been given an opportunity to have all my questions answered to my satisfaction. I also understand that we may consult at any time after the initial consultation to update the treatment as necessary. I understand and agree that it is my sole responsibility to comply with all information given regarding before and after care. I will not hold the Esthetician, Pua Manu MedSpa, Dr. Nancy Chen or Kapolei Eye Care responsible or liable for any noncompliance on my part or for any damages incurred otherwise.