• OxyGeneo Consult Form

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    You are being treated with the Geneo platform for anti-aging and/or skin brightening treatments. The platform works with OxyGeneo Technology.

    Special gel will be applied on your face and the treatment will be performed using an applicator with a disposable capsule attached to it.

    During the treatment the reaction between the capsule and the gel will cause the infusion of the active ingredients. 

    The treatment is none invasive, pleasant and does not require down time.

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  • Skincare Questionnaire
  • Have you had an OxyGeneo Super Facial before?*
  • What are your specific skincare concerns?*

  • What skincare products are you currently using at home?*
  • Have you ever had a reaction to skincare products/ingredients?*
  • Health Questionnaire
  • Existing or Recent Illness:*
  • Hospitalization/Surgery:*
  • Medication:*
  • Aesthetic procedures in the treatment area:*
  • Allergies (including to cosmetic procedures):*
  • Do any of the following apply to you? (Please indicate if any)
  • Photographic Consent & Release*

  • Treatment Agreement

    I, the client, agree to inform of all changes in my physical condition.

    I agree to undergo the treatment, as detailed below in this document. I was explained and understand the results, the reactions and the course of the treatment. 

    I confirm that I do not suffer from any of the above described conditions. 

    I have had the opportunity to consider the following information, ask questions and have had these answered satisfactorily.

  • Client Consent

    I understand that receiving the treatment is my choice and that I am free to withdraw at any time, without giving any reason.

    I was told about the possible side effects of the treatment including: local pain, excessive skin redness (erythema), excessive swelling (edema), damage to the natural skin texture (crust, blister, and burn), excessive tingling sensation, fragile skin and bruising. Although these effects are rare and expected to be temporary, any adverse reaction should be reported immediately.

    By signing below, I confirm that I have read and understand the above information and agree to undergo the treatment.

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  • Date
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    2 digit month, 2 digit day, 4 digit year
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