Patient Information 个人信息

Medical History 医疗历史

Consent Form 同意书

HIFU (High Intensity Focused Ultrasound) uses focused ultrasound energy to heat deeper layers of the skin, causing tissue tightening and stimulating new collagen production. This can improve the appearance of loose or ageing skin.

I understand that:

• Results vary between individuals and develop over 3–6 months.

• More than one session may be needed for best results.

• HIFU is non-invasive and will not achieve the same results as surgical procedures.

I agree to:

• Inform the practitioner of any changes to my medical history or medication before each session.

• Follow all aftercare instructions.

• Release the practitioner, clinic, and staff from liability related to this procedure.

• Ask questions at any time and I may withdraw consent whenever I choose.

Risks and Side Effects, I understand that HIFU is considered low-risk, but possible temporary side effects include:

• Mild discomfort during or after treatment

• Redness for a few hours

• Swelling, tingling, or tenderness for a few days to weeks

• Uncommon effects such as bruising or temporary raised bumps

Informed Decision, I confirm I have been advised about:

• The aims of treatment and expected benefits

• Possible risks and disadvantages

• Risks of refusing treatment

• Alternatives, including no treatment

• Any uncertainties regarding outcome

• Possible follow-up sessions

I have had the opportunity to discuss my goals, ask questions, and receive clear answers. No new information has changed my decision.

Consent, I certify that I have read and understand this consent form and voluntarily agree to proceed with HIFU treatment. This document represents full disclosure and replaces any previous information given.

我理解HIFU（高能量聚焦超声波）利用聚焦超声波能量加热皮肤深层组织，从而收紧组织并刺激新的胶原蛋白生成，以改善皮肤松弛或老化外观。

治疗效果与预期, 我理解并接受以下情况：

• 效果因人而异，且效果将在 3至6个月 内逐渐显现。

• 为达到最佳效果，可能需要进行一次以上的治疗。

• HIFU是非侵入性治疗，其效果无法与外科拉皮手术等同。

我的责任与义务, 我同意：

• 在每次治疗前，向医生告知我的健康状况或所用药物发生的任何变化。

• 严格遵守所有推荐的术后护理指导。

• 免除医生、诊所及其工作人员与本次治疗相关的任何责任。

• 我随时可以提问，并有权在任何时候撤回本同意。

风险与副作用, 我理解HIFU被认为是低风险的，但可能出现的暂时性副作用包括：

• 常见副作用：治疗期间或治疗后出现轻微不适；皮肤发红数小时；肿胀、刺痛或触痛，可能持续数天至数周。

• 不常见副作用：淤青或暂时性皮肤隆起（风团）。

知情决策确认, 我确认本人已获知并理解以下信息：

• 治疗的目标与预期益处。

• 可能的风险与不利之处。

• 拒绝治疗的风险。

• 其他替代治疗方案（包括不进行治疗）及其利弊。

• 关于治疗效果的任何不确定性。

• 可能需要的后续治疗。

我已获得充分机会与医生讨论我的治疗目标，我所有的问题均已得到满意解答。没有新出现的信息影响我接受治疗的决定。

最终同意

我证明已阅读并理解本知情同意书全部内容，并自愿同意接受HIFU治疗。本文件构成完整的披露说明，并取代之前任何口头或书面的信息。