Cryopen Consent

CryoPen™ cannot be used if you are taking Antihistamines and you would need to have a break from them for3 days prior to treatment.

Contra-indications:

• Not suitable for pregnant or breast-feeding women.
• Agammaglobulinemia (inherited cold intolerance, higher risk of infection.
• Cold uticaria. (Hives when cold)
• Concurrent dialysis treatment.
• Collagen vascular disease.
• Autoimmune diseases.
• Rheumatoid arthritis.Temporal Arthritis.
• Scleroderma (cranial arthritis, Giant cell arthritis)Immunosuppression, immunodeficiency disorders. (high infection risk)Multiple myloma (Cancer starting in bone marrow plasma cells)
• Pyoderma Gangrenosum ( ulcerating/necrotic condition, usually found on legs.)Platelet deficiency.Human T-cell Lymphotropic virus III.
• Lymphademoopathy associated virus.
• Form of Creutzfieds Jakob Disease, CJD, TSE, vCJD, nvCJD.
• Dermal fillers under the site to be treated

 

CryoPen™ is not recommended for darker skin types as it will kill the melanocytes in the surrounding area and the skin in that area will become lighter, basically just swapping one concern for another. 

I understand that the treatment may involve risks of complication or injury from both known and unknown causes, and I freely assume those risks. Prior to receiving treatment, I have been candid in revealing any condition that may have a bearing on this procedure.

I consent and authorise Paige Edmonds to perform one or more Cryopen treatments on me. I certify that I have read this entire informed consent and I understand and agree to the information provided in the form. My questions regarding the procedure have been answered satisfactorily.

I hereby release Paige Edmonds from all liabilities associated with this procedure. This consent is valid for all of my Cryopen treatments in the future as well.