Consent Form

INTRODUCTION

Orion® Cold Plasma is a non-invasive aesthetic treatment that utilizes Cold Atmospheric Plasma (CAP) technology. Cold plasma is an ionized gas containing reactive oxygen and nitrogen species that may support skin rejuvenation, tissue repair, circulation, and skin barrier health without causing significant thermal injury.

Orion Cold Plasma may be used alone or in combination with other aesthetic and regenerative treatments including exosomes, PDRN, growth factors, platelet-rich plasma (PRP), microneedling, mesotherapy, neurotoxins, dermal fillers, biostimulators, and skin rejuvenation procedures.

I understand that Orion Cold Plasma is an elective cosmetic procedure and that individual results vary.

TREATMENT BENEFITS

Potential benefits may include:

• Improved skin texture
• Improved skin tone
• Reduction in redness and inflammation
• Support of skin barrier function
• Improvement in acne-prone skin
• Improvement in appearance of scars
• Enhanced penetration of topical regenerative products
• Improved healing response
• General skin rejuvenation

I understand that results vary and cannot be guaranteed.

I understand that multiple treatments may be recommended to achieve optimal outcomes.

OFF-LABEL USE ACKNOWLEDGMENT

I understand that aesthetic applications of Cold Atmospheric Plasma may not be specifically cleared or approved by the U.S. Food and Drug Administration (FDA) for every cosmetic indication being treated.

I understand that recommendations are based on clinical judgment, available scientific evidence, manufacturer guidance, and my provider's experience.

POSSIBLE RISKS AND SIDE EFFECTS

I understand that although Orion Cold Plasma is generally considered a low-risk treatment, side effects and complications may occur. Potential side effects include:

• Temporary redness
• Mild swelling
• Warmth in treatment area
• Tingling sensation
• Temporary skin sensitivity
• Dryness
• Mild itching
• Temporary irritation
• Temporary acne flare
• Temporary worsening of existing skin conditions
• Unsatisfactory cosmetic outcome
• Lack of improvement

Rare or unforeseen complications may occur despite proper treatment.

NO GUARANTEE OF RESULTS

I understand:

• Results vary from person to person.
• Improvement may be gradual.
• Multiple sessions may be required.
• Maintenance treatments may be recommended.
• Lifestyle, age, genetics, sun exposure, medical conditions, and skincare habits may influence results.
• No guarantees or warranties have been made regarding the outcome of treatment.

POST-TREATMENT INSTRUCTIONS

I agree to follow all pre-treatment and post-treatment instructions provided by Emergent Medtech.

I understand that failure to follow instructions may increase the risk of complications and may negatively impact my results.

FINANCIAL RESPONSIBILITY

I understand that Orion Cold Plasma treatment is elective and cosmetic in nature and is generally not covered by insurance.

I accept full financial responsibility for all treatment-related fees.

RELEASE AND ACKNOWLEDGMENT

I acknowledge that medicine and aesthetic medicine are not exact sciences.

I understand that no guarantee or warranty has been made regarding the outcome of my treatment.

I voluntarily consent to Orion Cold Plasma treatment and accept the known and unknown risks associated with the procedure.

I release and hold harmless Emergent Medtech, employees, contractors, and affiliates from liability arising from known or unforeseen complications except in cases of gross negligence or willful misconduct as permitted under Ohio law.

PATIENT CERTIFICATION

I certify that:

• I have read and understand this consent form.
• I have disclosed all relevant medical history.
• I have had the opportunity to ask questions.
• My questions have been answered to my satisfaction.
• I voluntarily consent to treatment.