Client Consent: Post-Operative Care

Client Consent: Post-Operative Care

All information must be answered truthfully and correctly to ensure the best service possible. All information will remain private and confidential.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Emergency Contact

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
Name of country and surgeon that completed your treatment?
How far along are you in your post-operative journey? Please include date of surgery
Please list all procedures completed during surgery (liposuction, BBL, tummy tuck, etc.):
Please list all medications and/or medical conditions. If there anything else that may NOT have been listed above that your treatment provider should know about, please also list this below.
I understand that the post-operative care I receive is provided for the basic purpose of recovery. Manual Lymphatic Drainage (MLD) is a gentle and effective treatment to speed up the movement of lymph fluid to relieve pain, swelling, assist the body's own healing processes, boosts immunity, and reduce's the chances of scar formation.

If I find to have complications regarding my recovery, I will advise my treatment provider and seek my available options. I understand that if any complications arise during my recovery, my treatment provider is not at fault.

I have stated all my known medical conditions and answered all questions truthfully. The treatment provider will keep all of my health information private and confidential.

I consent to the use of photography for the purpose of marketing while remaining anonymous.
Signature
Date

MonthDayYear
Date
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