Geneveve Screening and Consent Form

  • PATIENT INFORMATION
  • SCREENING CRITERIA
  • COMORBIDITY/RISK FACTORS
  • Treatment at discretion of provider.
    Note: Device has not been evaluated for use in:
    • Post-menopausal women, or
    • Women who have NOT had at least one vaginal delivery.
  • PATIENT CONSENT
  • In considering a treatment, please read the following information carefully and discuss any questions you may have with your physician.

    It has been explained to me that the device delivers a low amount of radiofrequency energy to the tissue inside the vagina near the opening. While there is no downtime, the tissue may be tender from the surface cooling applied during the treatment. Therefore I understand it is important to follow my doctor’s timeline for refraining from intercourse or insertion of tampons so as not to irritate the area.

    It has been explained to me that the results vary from person to person given the amount of tissue laxity and my body’s own natural response to the treatment. I also understand I may not start to feel a difference until approximately one month after treatment and that the results will build gradually in the months following. It has been explained to me that the non-surgical treatment is not intended to provide the same results as a surgical procedure.

    I understand that increased friction resulting from tightening of the vaginal opening is one of many factors contributing to sexual satisfaction.

    I have read and understand all the information presented and I authorize to receive the Geneveve Treatment from the following practice: Dr. Lisa Gardner/FUSION MEDICAL AESTHETICS.