FairyJet Device Consent Form

FairyJet Device Consent Form

Patient & Provider Information

Introduction / Purpose

FairyJet is a non-invasive device designed for wellness and aesthetic enhancement. It combines microcurrent, gentle suction, and air-assisted infusion to improve circulation, skin texture, and overall wellness.

Intended benefits may include:

  • Improved lymphatic drainage and circulation

  • Enhanced skin tone and texture

  • Reduction of puffiness and mild inflammation

  • Support for localized wellness and relaxation

Treatment Overview / How It Works

  • The device delivers targeted microcurrents and air-assisted infusion through specialized tips or applicators

  • Treatments typically last 20–30 minutes per session

  • Sessions may be repeated per provider recommendation for optimal results

Contraindications & Warnings

Do not use FairyJet if you have:

  • Open wounds, active infections, or severe skin conditions in treatment area

  • Implanted electronic devices (e.g., pacemakers)

  • Known allergies to skincare products used during treatment

  • Pregnancy or breastfeeding (unless approved by provider)

Caution is advised for patients with sensitive skin, rosacea, or chronic dermatologic conditions.

Possible Risks / Side Effects

  • Temporary redness, mild tingling, or warmth at the treatment site

  • Minor bruising or irritation

  • Rare: allergic reaction to skincare products used during treatment

Pre-Treatment Instructions

  • Remove makeup and cleanse the treatment area prior to arrival

  • Inform provider of any allergies, medications, or recent procedures

  • Avoid heavy creams, exfoliants, or harsh treatments 24–48 hours before session

During Treatment / Application

  • Patient remains seated while provider operates the FairyJet device

  • The applicator may be moved over target areas, providing gentle suction and microcurrent stimulation

  • Patient should immediately notify the provider of discomfort

Post-Treatment / Aftercare

  • Avoid heavy skincare products, direct sun exposure, or vigorous activity for 24 hours

  • Maintain hydration and follow any post-care instructions provided

  • Schedule follow-up sessions as recommended by provider for optimal results

Patient Responsibilities

  • Follow provider instructions before, during, and after treatment

  • Report any discomfort or adverse reactions promptly

  • Attend recommended sessions for best outcomes

Acknowledgment & Consent

I acknowledge that:

  • I have read and understood this consent form

  • I understand the benefits, risks, and alternatives of FairyJet treatment

  • I consent to the procedure and accept responsibility for my safety

  • I release AI Wellness Center of Excellence, its staff, and affiliates from any liability except in cases of gross negligence or willful misconduct

I consent to photos or video for educational or promotional purposes, if applicable