Solstice Body & Esthetics By Tiara Body Contouring Consent Form

Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender
Height
Weight
Desired Body Contouring Service
Desired Treatment Area
Have you ever received any body treatments or liposuction?
If yes, what procedure(s) did you receive, when did you receive them, and what body area?
For optimal results, 9-12 sessions are recommended for cavitation, skin tightening, butt enhancement and wood therapy. How many sessions are you interested in?
Do you suffer from any skin diseases?
If yes, what are the skin conditions that you suffer from?
I acknowledge that:
Further, I acknowledge that:
Body Contouring Official Photo Release Form
I understand that before and after photos are required for liabilty and legal purposes. I authorize my before and after photos and videos to be taken and used in/or for all promotional material to be showcased in, but not limited to, social media posts, newsletters, websites, marketing campaigns, and other print and digital campaigns, without payment or any other consideration. This authorization is in effect indefinitely.
I, , of legal age, grant permission to Tiara Washington (esthetician)to use my photos in its digital ad campaign, which includes digital and print media.
By signing this form, I am agreeing to the release of my photos for commercial use.
Body Contouring Medical Questionnaire
Health/Serious Illnesses (are you currently suffering or have suffered from anyof the following)?
If yes, please list
Any conditions already being treated by a practitioner?
Use of recreational drugs or alcohol?
Before & After Care Instructions
It is ESSENTIAL that you follow these instructions for optimal results from Cavitation treatments!!!!

WEEK PRIOR TO TREATMENT IF POSSIBLE- IF NOT, DAYS PRIOR:
- Liberal water intake: More than 32 ounces per day
- OK to take ALL medications, even diuretics (substance that increases flow of urine)
- DO NOT BINGE EAT!!!!
- DO NOT DRINK ALCOHOL THE NIGHT BEFORE I-LIPO!!!!
DAY OF TREATMENT - PRIOR TO TREATMENT:
- Drink 24 ounces of water (coffee, tea, cola DOES NOT COUNT AS WATER)!!!!
- HOLD diuretics until day after (if applicable)
- Take normal medications, but DO NOT take diuretics
- Do not drink caffine 3-4 hours prior to treatment
- Do not have a heavy meal prior to treatment. Not eating will make your body go into starvation mode and your treatment results will not be as significant.
IMMEDIATELY AFTER I-LIPO:
- YOU MJST PARTICIPATE IN AEROBIC EXERCISE (walk, run on a treadmill, cycle, or elliptical exercise). The longer the exercise, the more likely it is that the fat that was mobilized into circulatory system will leave the body! Drink another 36 ounces of water after hard effort (exercise).
30 minutes exercise = 40-60% of fat metabolized = FAIR RESULTS

45 minutes exercise = 60-80% of fat metabolized = GOOD RESULTS

60 minutes exercise = 80-100% of fat metabolized = EXCELLENT RESULTS
- DO NOT DRINK ALCOHOL AND DO NOT BINGE EAT!!!!
You may experience hunger cravings because a lot of fat has been metabolized and your body is not used to that! Fight the hunger pains (if any) stick to good eating habits and drink plenty of water.

DAY AFTER TREATMENT:
- Continue liberal water intake
- Resume diuretics (if applicable)
- Watch your appetite as it may increase - DO NOT increase normal calorie intake
- Exercise if possible - remember a large amount of fat has been dumped into the circulatory system and it's important to burn all that you can to prevent it from restoring
PLEASE REMEMBER THAT YOU HAVE LOST A SIGNIFICANT AMOUNT OF FAT FROM ONE AREA OF YOUR BODY BUT THE WEIGHT LOSS CAN BE REVERSED BY:
- DRINKING ALCOHOL
- BINGE EATING (eat 4-6 meals daily and spread out your calorie intake)
- EATING TOO MUCH CARBOHYDRATES
By signing this form, I declare that I am of legal age and give my full consent to the Body Contouring treatment. I have fully read and understand the contents provided herein and I assume the risks involved, including any complications and benefits resulting from the foregoing. I have had the opportunity to ask questions and clarifications and by which I have received answers to my satisfaction. I am executing this consent with full knowledge and responsibility to my actions.
Signature
Date Signed

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Should be Empty:

Body Contouring Official Photo Release Form

Body Contouring Medical Questionnaire

Before & After Care Instructions