Energist UltraPlus VPL™ System
User Manual
SD1-43 Issue 3 (CCF 296)
92
Consent form and treatment protocol
Consent documentation
must
be completed on every occasion in which
the Energist Ultra VPL
TM
system is to be used, including test-patches,
training visits, demonstrations, in-house clinics and on any other occasion
in which the machine is to be used on a person. This includes treatments
on other members of your staff, family, friends and members of the
public. A test-patch
must
be completed before treatment.
Please tick and date each section and keep a copy for your files.
Type of session (e.g. demo/training etc.) ………………….
Date of session
………………….
Location of session
………………….
Name of Trainer
………………….
Test patch completed
………………….
Any adverse reactions to test patch ………………….
If yes, list
………………….
………………………………………………………………
………………………………………………………………
………………………………………………………………
………………………………………………………………
Number of people present
…………………..
Names of people present …………………..
…………………..
…………………..
…………………..
…………………..
…………………..
Any skin observations to note
Energist Ltd. test-patch consent form