Consent Form

INTRODUCTION

CellSound® is a non-invasive aesthetic treatment that utilizes proprietary ElectroSonic Resonance® technology, combining non-focused ultrasound and an electro-stimulation field. The treatment is intended to support skin rejuvenation, improve skin appearance, enhance circulation, stimulate collagen production, improve skin laxity, and assist with body contouring and cellulite reduction. According to manufacturer materials, the technology is designed to stimulate cellular activity without thermal injury or tissue destruction.

I understand that CellSound® is considered an elective cosmetic procedure and that individual results vary.

ACKNOWLEDGMENT OF OFF-LABEL AND COSMETIC USE

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

I understand that recommendations made by my provider are based on clinical judgment, available evidence, manufacturer guidance, and individual patient needs.

BODY CONTOURING DISCLOSURE

If CellSound® is being used for body contouring, cellulite reduction, or body sculpting:

I understand:

• CellSound® is not a weight-loss procedure.
• Results vary significantly between individuals.
• Healthy diet and exercise remain essential.
• Lost inches or body contour improvements cannot be guaranteed.
• Weight gain after treatment may reduce or reverse results.

FACIAL REJUVENATION DISCLOSURE

If CellSound® is being used for facial rejuvenation:

I understand:

• Improvements are gradual.
• Multiple sessions are often recommended.
• Maintenance treatments may be required.
• Aging will continue despite treatment.
• Results vary according to age, genetics, lifestyle, and skin quality.

TREATMENT GOALS

Potential treatment benefits may include:

• Improved skin texture
• Improved skin tone
• Enhanced skin firmness
• Reduction in the appearance of fine lines and wrinkles
• Improvement in mild skin laxity
• Reduction in the appearance of cellulite
• Body contouring support
• Improved circulation and lymphatic flow
• General facial rejuvenation

I understand that results are not guaranteed and may require multiple treatments for optimal outcomes.

POSSIBLE RISKS AND SIDE EFFECTS

I understand that CellSound® is generally considered a low-risk, non-invasive procedure; however, complications may occur. Potential side effects may include:

• Temporary redness
• Mild swelling
• Warmth in treated area
• Tingling sensation
• Mild tenderness
• Temporary sensitivity
• Temporary itching
• Temporary muscle soreness
• Bruising (rare)
• Headache (rare)
• Lack of improvement
• Unsatisfactory cosmetic outcome

Although uncommon, unforeseen complications may occur.

I understand that no guarantee has been made regarding my results.

POST-TREATMENT INSTRUCTIONS

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

I understand that failure to follow instructions may negatively affect my outcome.

FINANCIAL ACKNOWLEDGMENT

I understand that cosmetic procedures are elective and generally not covered by insurance.

I am financially responsible for all charges associated with my treatment.

RELEASE OF LIABILITY

I acknowledge that medicine and aesthetics are not exact sciences.

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

I voluntarily consent to undergo CellSound® treatment and accept the known and unknown risks associated with the procedure.

I release and hold harmless Emergent Medtech, its owners, medical director, providers, 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 understood this document.
• All of my questions have been answered.
• I understand the risks, benefits, and alternatives.
• I consent voluntarily to treatment.