Registration form

Franciele SofiatiBiomedic | Esthetician | Cosmetologist

Registration, booking details and consent records to prepare your care clearly before the consultation.

CRBM 6277 · Metropolitan Med Center, Londrina - PR

Section 1 of 21

Introduction and initial acknowledgement

This form records prior acknowledgement and consent. It does not replace an in-person assessment, individual guidance, clinical intake, medical record, physical examination, skin analysis, contraindication review or personalised instructions.

The procedure depends on assessment by the responsible professional, appointment availability, booking-fee confirmation when applicable, safe conditions on the appointment day and absence of contraindications.

I have read and understood that this form is preliminary and complementary, does not replace an in-person assessment, and that the procedure may be confirmed, adapted, postponed, interrupted or contraindicated for safety reasons.

Section 2 of 21

Client identification

Email *

Full name *

Preferred name *

CPF / tax ID *

Identity document *

Number, issuing body and state/country

Phone / WhatsApp *

Include country and area code.

Date of birth *

Address and postal code *

Are you over 18? *

Legal guardian details, if applicable *

If this does not apply, write "Not applicable".

Identity document upload *

Choose fileNo file selected

RG/CIN, driver licence, RNM, passport or official photo ID. Maximum 10 MB.

Section 3 of 21

Scheduling, booking fee, cancellation and no-show

To reserve the time, room, professional schedule and, where applicable, equipment, handpiece, machine or technology, a booking fee of 30% of the total procedure value may be charged. This fee is deducted on the appointment day when the client attends and the procedure is performed.

Rescheduling with 24 hours or more notice: the fee is kept as credit for a new date, subject to availability.
Cancellation with 24 hours or more notice: the fee may be converted into credit or refunded depending on the case and costs already assumed.
Less than 24 hours notice, delay that prevents safe care, or no-show: the fee may be retained.
Rented or reserved equipment may justify retention to cover committed costs.
Cancellation by the professional for technical, sanitary, ethical or safety reasons allows rescheduling, credit or refund of the amount corresponding to the procedure not performed.

I have read and understood the 30% booking-fee, cancellation, rescheduling, delay and no-show policy.

Booking-fee payment receipt *

Choose fileNo file selected

PDF or image, maximum 10 MB.

Section 4 of 21

Desired procedure

Area or body region to be treated *

Agreed appointment date *

Agreed time *

Laser Harmony - Ponteiras LIP, PIXEL, Elektra ND:YAG Q-SwitchedSpots, freckles, dark circles, tattoo, micropigmentation, rosacea, facial vessels, texture, scars, pores, stretch marks and rejuvenation.

Read complete specific term

Laser Harmony specific informed consent

This English reference paragraph corresponds to section 5 of the official Portuguese consent document and covers the corresponding clause from the Portuguese source document. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P1.

This English reference paragraph corresponds to section 5 of the official Portuguese consent document and covers risks and possible reactions. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P3.

This English reference paragraph corresponds to section 5 of the official Portuguese consent document and covers absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P4.

This English reference paragraph corresponds to section 5 of the official Portuguese consent document and covers privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P5.

This English reference paragraph corresponds to section 5 of the official Portuguese consent document and covers privacy, LGPD and data processing, pre- and post-procedure care. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P6.

This English reference paragraph corresponds to section 5 of the official Portuguese consent document and covers privacy, LGPD and data processing, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P7.

This English reference paragraph corresponds to section 5 of the official Portuguese consent document and covers booking fee and payment conditions, privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P8.

I have read and understood the complete specific term for this procedure.

Laser hair removal - LightSheer DuetProgressive hair reduction and aesthetic support for folliculitis or ingrown hairs.

Read complete specific term

LightSheer Duet laser hair removal specific informed consent

This English reference paragraph corresponds to section 6 of the official Portuguese consent document and covers the corresponding clause from the Portuguese source document. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P1.

This English reference paragraph corresponds to section 6 of the official Portuguese consent document and covers privacy, LGPD and data processing, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P3.

This English reference paragraph corresponds to section 6 of the official Portuguese consent document and covers privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P4.

This English reference paragraph corresponds to section 6 of the official Portuguese consent document and covers privacy, LGPD and data processing, pre- and post-procedure care. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P7.

This English reference paragraph corresponds to section 6 of the official Portuguese consent document and covers privacy, LGPD and data processing, pre- and post-procedure care. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P8.

This English reference paragraph corresponds to section 6 of the official Portuguese consent document and covers booking fee and payment conditions, privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P10.

I have read and understood the complete specific term for this procedure.

Botulinum toxinFacial Botox and Nefertiti technique for neck and jawline, according to assessment.

Read complete specific term

Botulinum toxin specific informed consent

This English reference paragraph corresponds to section 7 of the official Portuguese consent document and covers the corresponding clause from the Portuguese source document. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P1.

This English reference paragraph corresponds to section 7 of the official Portuguese consent document and covers privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P2.

I have read and understood the complete specific term for this procedure.

CO2 laser - AcuPulse CO2Deep rejuvenation, scars, wrinkles, laxity, texture and more intensive recovery.

Read complete specific term

CO2 laser specific informed consent

This English reference paragraph corresponds to section 8 of the official Portuguese consent document and covers privacy, LGPD and data processing, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P1.

This English reference paragraph corresponds to section 8 of the official Portuguese consent document and covers privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P2.

This English reference paragraph corresponds to section 8 of the official Portuguese consent document and covers privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P4.

This English reference paragraph corresponds to section 8 of the official Portuguese consent document and covers risks and possible reactions, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P5.

This English reference paragraph corresponds to section 8 of the official Portuguese consent document and covers privacy, LGPD and data processing, pre- and post-procedure care. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P6.

This English reference paragraph corresponds to section 8 of the official Portuguese consent document and covers privacy, LGPD and data processing, pre- and post-procedure care. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P8.

This English reference paragraph corresponds to section 8 of the official Portuguese consent document and covers booking fee and payment conditions, privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P9.

This English reference paragraph corresponds to section 8 of the official Portuguese consent document and covers the corresponding clause from the Portuguese source document. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P10.

I have read and understood the complete specific term for this procedure.

Ultraformer MPT ultrasoundFacial or body laxity, double chin, facial contour and selected localised fat.

Read complete specific term

Ultraformer MPT specific informed consent

This English reference paragraph corresponds to section 9 of the official Portuguese consent document and covers privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P1.

This English reference paragraph corresponds to section 9 of the official Portuguese consent document and covers risks and possible reactions, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P2.

This English reference paragraph corresponds to section 9 of the official Portuguese consent document and covers privacy, LGPD and data processing, pre- and post-procedure care. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P3.

This English reference paragraph corresponds to section 9 of the official Portuguese consent document and covers privacy, LGPD and data processing, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P4.

This English reference paragraph corresponds to section 9 of the official Portuguese consent document and covers privacy, LGPD and data processing, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P5.

This English reference paragraph corresponds to section 9 of the official Portuguese consent document and covers booking fee and payment conditions, privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P6.

This English reference paragraph corresponds to section 9 of the official Portuguese consent document and covers the corresponding clause from the Portuguese source document. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P7.

I have read and understood the complete specific term for this procedure.

RadiofrequencyEstimulo de colageno para flacidez, rugas, textura, estrias, fibroses e qualidade da pele.

Read complete specific term

Radiofrequency specific informed consent

This English reference paragraph corresponds to section 10 of the official Portuguese consent document and covers privacy, LGPD and data processing, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P1.

This English reference paragraph corresponds to section 10 of the official Portuguese consent document and covers the corresponding clause from the Portuguese source document. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P2.

This English reference paragraph corresponds to section 10 of the official Portuguese consent document and covers booking fee and payment conditions, privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P3.

This English reference paragraph corresponds to section 10 of the official Portuguese consent document and covers privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P6.

I have read and understood the complete specific term for this procedure.

Plasma jetEyelids, fine lines, localised laxity and selected small benign lesions.

Read complete specific term

Plasma jet specific informed consent

This English reference paragraph corresponds to section 11 of the official Portuguese consent document and covers privacy, LGPD and data processing, pre- and post-procedure care. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P1.

This English reference paragraph corresponds to section 11 of the official Portuguese consent document and covers privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P2.

This English reference paragraph corresponds to section 11 of the official Portuguese consent document and covers privacy, LGPD and data processing, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P6.

This English reference paragraph corresponds to section 11 of the official Portuguese consent document and covers booking fee and payment conditions, privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P7.

This English reference paragraph corresponds to section 11 of the official Portuguese consent document and covers the corresponding clause from the Portuguese source document. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P8.

I have read and understood the complete specific term for this procedure.

MMP / Mesoterapia capilarQueda de cabelo, calvicie, afinamento, couro cabeludo e fortalecimento capilar.

Read complete specific term

Hair MMP and mesotherapy specific informed consent

This English reference paragraph corresponds to section 12 of the official Portuguese consent document and covers booking fee and payment conditions, privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P1.

This English reference paragraph corresponds to section 12 of the official Portuguese consent document and covers the corresponding clause from the Portuguese source document. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P2.

This English reference paragraph corresponds to section 12 of the official Portuguese consent document and covers privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P4.

I have read and understood the complete specific term for this procedure.

Body or facial MMPStretch marks, spots, melasma, texture, skin quality and microinfusion of actives.

Read complete specific term

Body and facial MMP specific informed consent

This English reference paragraph corresponds to section 13 of the official Portuguese consent document and covers booking fee and payment conditions, privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P1.

This English reference paragraph corresponds to section 13 of the official Portuguese consent document and covers the corresponding clause from the Portuguese source document. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P2.

This English reference paragraph corresponds to section 13 of the official Portuguese consent document and covers privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P4.

I have read and understood the complete specific term for this procedure.

PEIM - tecnica microinjetavelAesthetic treatment of selected superficial leg microvessels.

Read complete specific term

PEIM microinjectable vessel treatment specific informed consent

This English reference paragraph corresponds to section 14 of the official Portuguese consent document and covers booking fee and payment conditions, privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P1.

This English reference paragraph corresponds to section 14 of the official Portuguese consent document and covers the corresponding clause from the Portuguese source document. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P2.

This English reference paragraph corresponds to section 14 of the official Portuguese consent document and covers privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P4.

I have read and understood the complete specific term for this procedure.

Mechanical peelingDiamond, crystal or ultrasonic peeling for superficial renewal.

Read complete specific term

Mechanical peeling specific informed consent

This English reference paragraph corresponds to section 15 of the official Portuguese consent document and covers booking fee and payment conditions, privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P1.

This English reference paragraph corresponds to section 15 of the official Portuguese consent document and covers the corresponding clause from the Portuguese source document. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P2.

This English reference paragraph corresponds to section 15 of the official Portuguese consent document and covers privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P4.

I have read and understood the complete specific term for this procedure.

Peeling quimicoRetinoico, Jessner, ATA, MELAN ou protocolos compativeis para manchas, acne, melasma, poros e textura.

Read complete specific term

Chemical peeling specific informed consent

This English reference paragraph corresponds to section 16 of the official Portuguese consent document and covers booking fee and payment conditions, privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P1.

This English reference paragraph corresponds to section 16 of the official Portuguese consent document and covers the corresponding clause from the Portuguese source document. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P2.

This English reference paragraph corresponds to section 16 of the official Portuguese consent document and covers privacy, LGPD and data processing, risks and possible reactions, pre- and post-procedure care, absence of result guarantee. The Portuguese form remains the governing source for the exact clause wording. Reference marker S0-P4.

I have read and understood the complete specific term for this procedure.

Sections 17 and 18 of 21

Safety, contraindications and general risks

This form does not replace the clinical intake completed at the clinic. Tell us about pregnancy, possible pregnancy, breastfeeding, allergies, medication, diseases, infections, wounds, sun exposure, tanning, recent procedures, acid use, sensitivity or any relevant information.

Allergy, health condition, medication or important situation *

If there is nothing to report, write "No".

I have read and understood the general risks, limitations, absence of result guarantee and my responsibility to follow pre- and post-procedure instructions.I declare that the information provided is true and that I have not omitted information relevant to my safety.

Section 19 of 21

Photo record, image, testimonial and marketing

Technical procedure record *

Use of image in marketing and social media *

I understand that I may revoke authorisation for new publications in writing through the official channel.

Section 20 of 21

Privacy, LGPD and digital communication

I authorise the processing of personal data and, where applicable, sensitive data for identification, age confirmation, scheduling, communication, guidance, billing, receipts, consent records, legal/professional obligations, defence of rights and contact by WhatsApp, phone, email or social media.

I agree to the processing of my personal data for identification, scheduling, care, communication, billing, consent records and legal/professional obligations.I specifically authorise the processing of data related to the aesthetic procedure, images of the treated area and health information that I voluntarily provide.

Promotional communication *

Signature and submission

I declare that I have read, understood and accept the terms, conditions, consents and authorisations selected in this form.

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