INFORMATION AND INFORMED CONSENT FORM


I have been fully informed about the nature and objectives of the session, the procedure that will be carried out on me, its risks, benefits and the possible alternative options to achieve the desired purpose. I recognize that I have not been given guarantees or assurances regarding the expected results. I understand that this practice is not an exact science that is influenced by multiple factors such as the quality, depth and quantity of the ink, the type of skin, the length of time the tattoo has been carried out, or the place on the body where it is located.
I have received both verbal and written information in terms understandable to me.

IT HAS BEEN SPECIALLY EXPLAINED TO ME:

Directions for application:
If you are taking any medication, consult your doctor before starting the technique to be performed.
1. Do not sunbathe and UVA rays
2. Do not take stimulants such as tea, coffee, soft drinks with caffeine or theine, or substances with stimulant components.
3. Do not drink alcohol, vasodilators or anticoagulants
4. Do not eat seafood or spicy foods.

1. The objective of this technique is to eliminate the tattoo, using energy pulses, using a specific device with different filters with the intention of combining them if necessary for the treatment to be truly effective.
2. The treatment consists of destroying the ink particles using a beam of light that is selectively absorbed by these aforementioned ink particles. These particles explode and fragment without damaging the surrounding tissues. The effect of this high-energy radiation is translated by a photo-acoustic effect with mechanical shock on the tissues, with a splash and a snap being appreciated, observing the detachment of epidermal waste when the laser hits the treated area, which will cause a white coloration. ash. The pigment becomes colorless and is eliminated by fragmentation and chemical alteration. Repeating the treatment may be necessary to achieve better results; the number of sessions varies depending on the type of skin, type of ink used, the client's lifestyle, etc.
3. I understand and accept that the number of sessions necessary depends on the aforementioned factors, with the average for the color black being between 6 and 8 sessions but that they may be more, and that the color needs an average of between 10-15 sessions and may be more. , all this without the use of anesthetic products or creams that would in any case be applied at my home, notifying the technician before the session. With the use of these products or anesthetic creams, the number of sessions necessary can be multiplied, even exceeding 20 sessions that the removal of the tattoo between 70 and 90% will be considered a success, and the 100% of the removal cannot be guaranteed.

5. I understand that despite the appropriate choice of treatment and its correct execution, undesirable effects may occur, such as swelling, bruising, hyperpigmentation, hypopigmentation, scabs and blisters (the latter two caused by insufficient hydration in the healing of the skin) and which are usually transitory. The laser operator explained to me that the treatment is performed on an outpatient basis and gave me specific recommendations. He has also warned me that I should not sunbathe before and after each session and that I must use sun protection daily. He has also warned me that it is important to know my personal history of possible allergies to medications, coagulation disorders, cardiopulmonary diseases, existence of prostheses, pacemakers or current medications, history of herpes simplex, personal or family history of keloids or any other circumstance that may alter or interfere with the result of the treatment. In my particular case I have been warned about
6. In my particular case, it has been advised that this is the most appropriate treatment, although there may be other alternatives that would be indicated in another case that I have had the opportunity to discuss with the operator. I have also been informed of the possible consequences of not carrying out the treatment proposed to me. 7. I understand that during the course of treatment, or after it, unforeseen conditions may arise that require procedures different from those referred to here. Therefore, I expressly consent and request the use of techniques and the performance of the procedures that you deem necessary. 8. After the treatment, I agree to follow the guidelines, consultations and post-treatment care indicated to me. 9. I have understood the explanations that have been provided to me in clear and simple language, and the operator who has assisted me has allowed me to make all the observations and has clarified all the doubts that I have raised. Therefore, I declare that I am satisfied with the information received and that I understand the scope and risks of the treatment. 10. I confirm that I have read and fully understand the terms of this consent, that I have had the opportunity to ask questions and that these have been answered completely and satisfactorily. I have also been informed of the possibility of revoking this consent in writing at any time. 11. I attest that I have not omitted or altered any information when presenting my clinical and surgical history. 12. I give my express consent to be photographed or filmed before and/or after the treatment, on a scientific basis and for dissemination through social networks for advertising purposes and that my identity will never, under any circumstances, be revealed. 13. I acknowledge having been informed of all the circumstances and care that may arise after the session and that this establishment declines all responsibility for any damage that may be suffered by the person who does not attend to them.

User data

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Legal representative data

Informed consent, place, date and signature

I confirm that I have read and fully understand the terms of this consent, that I have had the opportunity to ask questions and that they have been answered completely and satisfactorily. I have also been informed of the possibility of revoking this tattoo removal consent in writing at any time.

Identification data:
Name of the centre
SACRED TATTOO AND PIERCINGS
5251073A
C/ Cádiz 16 18800 Baza

Person applying the technique
Cecilio Mateos Rubio
ID 457144581
Academic qualification: EGB
Professional Category: Tattoo artist and bander. Number 63

Person applying the technique:
Laser technician: Francisco García Montoro
CIF 7736419V
Phone: 695667254

In compliance with the General Data Protection Regulation 2016/679 and Organic Law 3/2018, of December 5, on the Protection of Personal Data and guarantees of digital rights, you are informed that your data will be included in an automated file. for its treatment, the person responsible for which is INTEGRALDIVA, SL, and whose purpose is the custody of the express consent necessary to manage the requested request. The data provided will be kept as long as the contractual relationship is maintained or for the years necessary to comply with legal obligations. The information provided will not be transferred to third parties except in cases where there is a legal obligation. You have the right of access, rectification, deletion, limitation of processing, portability or opposition of your data at C/Cádiz, 16. 1880 de Baza. Granada, or at the email address fina_actualsthetic@hotmail.com.
Check if you authorize the sending of offers and commercial communications related to those requested by any means (postal, email, WhatsApp, SMS, telephone), and this consent may be revoked at any time by the indicated means.
I authorize INTEGRALDIVA, SL to use its images and videos taken by the company for the promotion of the entity and to publish them on the website, social networks, calendars, media, etc. The data provided will be kept as long as the advertising management is maintained and will not be transferred to third parties except in cases where there is a legal obligation.

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