Fat Transfer

• The surgeon has provided me with medical advice, and I have agreed based on that advice to undergo the recommended surgical procedure of FAT TRANSFER.
• I have received the FAT TRANSFER Patient Information & Consent Document which I have read and understood IN FULL.
• I understand that I cannot have surgery if I am pregnant, breastfeeding and/or under the age of 18 and confirm that I am not pregnant, breastfeeding nor under the age of 18.
• I consent to the administration of any anaesthetics that are considered necessary or advisable by the doctor. I understand that all forms of anaesthesia involve risk and the possibility of complications, injury, and sometimes death.
• I have been advised by the doctor and I recognise and understand that during the operation, unforeseen conditions, which may not be known to the doctor at the time the procedure has commenced, may require different procedures than those stated above.
• I authorise and agree to the surgeon performing any such procedures that are in the exercise of his professional judgment necessary and desirable.
• The surgeon has explained the limitations of surgery and the risks involved in these surgical procedures, and I understand and accept these risks.
• I have had the opportunity to explain my goals to the surgeon and I understand which desired outcomes are realistic and which are not. I understand that there are no warranties implied or guaranteed about my outcomes.
• I consent to the disposal of any tissue, medical devices or body parts that may be removed during surgery.
• I consent to the utilisation of blood products should they be deemed necessary by the surgeon and I am aware that there are potential significant risks to my health with their utilisation as explained in the Information Document.
• I consent to the collection and storage of my personal medical information and for it to be disclosed for my ongoing care or if required by law.
• I consent for appropriate portions of my body to be photographed or filmed before, during, and after the procedure for medical, scientific or educational purposes, provided my identity is not revealed.
• The surgeon is a Cosmetic Doctor; therefore, Medicare rebates or Private Health Insurance rebates do not apply. I understand that most cosmetic procedures are not covered by Medicare.
• All my questions have been answered, and I understand the inherent risks of the procedure that I have consented to undergo, as well as those additional risks, possible complications, benefits, and the alternative treatments available to me.

SMOKING

• I understand that patients who smoke or use tobacco or nicotine products (patch, gum, nasal spray, or vaping) are at a greater risk for significant surgical complications.
• I understand that if I am currently smoking or use nicotine products, or if I have not abstained for the recommended amount of time, additional risks and complications will apply as explained in the Patient Information & Consent Document.
• I understand and accept that the clinic may request a nicotine test prior to surgery. If the test returns a positive result my surgery will be cancelled, and the total cost of hospital and anaesthetic fees for surgery will be forfeited and not returned.
• I understand and accept that the clinic may request a nicotine test at any stage during the recovery period. If the test returns a positive result and if a secondary surgery is required, I will be required to pay an additional surgeons’ fee of $1000.

COVID-19

• I understand that any symptoms of COVID-19 must be reported to the clinic. If I do not report symptoms my surgery will be cancelled and I will be responsible for the associated hospital and anaesthetic fees.
• I understand that if I need to cancel or reschedule my surgery due to COVID-19, I will NOT be financially penalised – provided the clinic has been notified with supporting documentation.

REVISIONS AND UNEXPECTED OUTCOMES

• I understand that my result may be unsatisfactory as the precise degree of improvement cannot be guaranteed. The outcome’s subjective nature also means dissatisfaction is a possible outcome regardless of of effectiveness of treatment.
• I understand that ALL surgical procedures carry risks, complications, and unforeseen problems that may require further expenditure. I accept and recognise that the fees paid are for a performance of the surgery only, and not a guaranteed result.
• I understand most cosmetic procedures have a 5% – 10% chance that a revision procedure is required to “touch up” or correct a complication that may have occurred: consistent with best practices worldwide.
• I understand that smooth breast implants carry an increased risk of capsular contracture (1 in 30).
• I understand that smooth breast implants or Motiva implants carry an increased risk of implant displacement.
• I will be financially responsible for fees associated with any future procedure. This may include (but not limited to): airfares, accommodation, carer, time off work, loss of income, medications, pathology, diagnostic investigations, surgical garments.
• I understand that I may require imaging studies in the future to determine the condition of my breast implants which will be my financial responsibility – MRI (Magnetic Resonance Imaging) scan or US (Ultrasound).
• If I require any future procedure, I will be responsible for the cost of third-party fees associated with hospital, anaesthetist, and implants (if required) –
• I understand that the surgeon’s fees are separate to aforementioned third-party fees. If a future procedure is required outside of the 12-month postoperative period, further expenditure will be required.
• I accept that the need for, and timing of revisions will be determined solely by the clinic.
• I understand and accept that where subsequent revision procedures become necessary all subsequent revision procedures provide results lower than results of a primary surgery.
• I understand that any future procedure that I require or elect to have, is not covered by the original quote or fees previously paid.
• I acknowledge that I have been informed of the risks and consequences associated with surgery. I accept responsibility for all clinical decisions, along with the financial costs of all future treatments.

ACCOUNTS AND PAYMENTS

• A $1000 booking deposit is required to be collected at the time of booking in order to secure my surgical date and time. This amount is NON-REFUNDABLE.
• I understand payment is required in full, 14 days prior to surgery. If payment has not been received, surgery will be cancelled and I will lose my booking deposit. An additional booking deposit may be required to reschedule.
• ALL rescheduling, for whatever reason, will be determined solely by the clinic.

CANCELLATIONS AND RESCHEDULING

• I understand that if I, for any reason, cancel my surgery more than 21 days prior to the date, all payment made, minus the $1000 booking deposit will be refunded.
• I understand that if I, for any reason, cancel my surgery less than 21 days prior to the date, the booking deposit + 50% of the payments made will be refunded. The remaining 50% will be forfeited and not returned to me.
• I understand that if I, for any reason, fail to attend my surgery without providing notice, all fees will be forfeited and not returned to me.
• I understand that if I, for any reason, reschedule my surgery, this must be done more than 21 days prior to the date.
• I understand that if I, for any reason, reschedule my surgery less than 21 days prior to the date, the booking deposit + 50% of the payments made will be forfeited and not returned to me. Additional payment will be required to reschedule.
• I understand that if the clinic needs to reschedule my surgery, I will be financially responsible for any out of pocket expenses associated with surgery, including but not limited to: airfares, accommodation, travel.

DISPARAGEMENT CLAUSE

• I agree that I will not make any disparaging comments about the surgeon that may cause hurt or embarrassment, damage their reputation, or defame them.
• This includes any comment or statement published either orally or writing on any digital, print, electronic or online media, including my own or third party internet sites, private or public forums without the written consent of Inigo Cosmetic.

CONFIRMATION OF CONSENT

• I hereby provide my fully informed consent to the surgeon to perform the surgical procedure, FAT TRANSFER.
• I understand this is purely, ELECTIVE COSMETIC SURGERY. I accept responsibility for the clinical decisions, along with the financial costs of any future procedures to revise, optimise, or improve outcomes.