2. I am hereby undertaking the responsibility of the treatment outcome.
3. I hereby commit to inform about any change in my medical and health condition.
4. I do not suffer from Herpes / I suffer from Herpes and I agree to initiate preventive treatment
with antiviral medications, though I am aware that preventive treatment does not ensure
total prevention of Herpes appearance during the treatment.
5. I understand the procedure is purely elective and that studies indicate that results vary with
each individual according to skin condition and physiological attributes as well as the
medical condition of the client.
6. I understand that a commitment to a series of treatments is required to achieve optimal
results and I am aware that the treatment may be performed by different Viora’s personnel.
7. I consent that Viora's clinical department may discontinue the treatment course at any time
without prior notice.
8. I consent to photographs for the purpose of monitoring response to treatment and for use in
medical education research of Viora and the local distributor as long as my anonymity is
maintained and my privacy protected.
9. I hereby declare that I was informed in regards to the following:
9.1 The versatile treatments available with Viora’s light based systems are based on a principle
called selective photothermolysis. The light emitted and absorbed by targeted chromophores
(light sensitive molecules) encourages a specific biological process to achieve the desired
9.2 I have been advised in regards to possible risks and side effects of the treatment which may
include slight pain, erythema, edema, color changes (hyper or hypo pigmentation), paradoxical
unwanted hair growth and burns. All side effects are transient and mild, however in the event
of adverse side effects the treating personnel must be informed and a physician consult may
9.3 I am aware that exposure to sun 3-4 weeks prior and after treatment are contraindicated to the
treatment and may promote side effects. I was advised to use SPF >30 in between treatments.
9.4 I was advised about the use of protective goggles and I agree to wear them throughout the
duration of the treatment.