Thank you for your interest in having your body sculpting procedure with us. We are with you on your desire to reach your goals for a better body that helps boost your confidence and bring a better lifestyle. We have provided some information that can help you achieve your best results: Drink plenty of water before and after treatment Have a 2-hour fast prior to treatment Perform some physical activity such as exercise Manage your food intake Avoid alcoholic drinks and those with high sugar before and after treatment Please take note that results may vary for the treatment. During the treatment, you might feel a warm discomfort. If it's not tolerable, please advise our technician.

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Medical History

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Are you pregnant or nursing?
Are you immunocompromised?
Do you have any liver or kidney disorders?
Do you have any thyroid gland dysfunction?
Do you have epilepsy?
Do you have cancer or a history of cancer?
Do you have photosensitivity to sun exposure?
Are you taking any drugs that may cause photosensitivity?
Have you undergone an organ transplant?
Do you have any current infections?
Do you have advanced untreated diabetes?
Do you have uncontrolled Hypertension?
Do you have any kind of heart condition?
Do you have hemophilia (blood clotting condition)?
Do you have a keloid scar?
Do you have any infectious disease or tuberculosis?
Do you have a pacemaker?

If you have answered 'Yes' to any of the medical conditions above, we advise you to see your doctor first before undergoing treatment with us. We reserve the right to not begin any treatment should we believe that such treatment may cause risk to our client due to the medical conditions which the client has.

Reminder:

Consent Form

Body sculpting increases flow of both the lymphatic and circulatory systems, and it also helps with cleaning of the tissues. The main use of body sculpting treatment is inch loss, diminishing of cellulite, and tightening of the skin.

Benefits:

Lose 1-3 inches per treatment with state-of-the-art equipment. Benefits are often immediate, but may be delayed in some people. Results may vary per body type.

For Best Results:

A series of 9-12 body sculpting treatments are recommended per each area, but some individuals may require more treatments to achieve maximum results. There should be at least 3 days between each treatment. This is not a weight loss treatment, but an inch loss. The inches will only return if the client goes back to their old habits. Eating the right types of food, proper exercise, and drinking 8 glasses of water per day are always recommended. For best results, it is recommended that you exercise within 4-6 hours of treatment and avoid sugar and alcohol for 24 hours after each treatment.

Precautions:

Body sculpting treatments are not recommended if you are pregnant, breast feeding, have a lymphatic disorder, acute illness, metal implants, pacemakers, or are currently being treated for active cancer.

Waiver:

I understand that I am using Gaia Body Sculpting machines provided at my own risk. Should I sustain an injury while using the equipment, I agree to not hold Gaia Body Sculpting service provider responsible.

Acknowledgement:

I understand and acknowledge that payments for the above services are non- refundable. By my signature below, I certify that I have read and understand the contents of this Consent Form for Body Contouring. I further agree to provide 24- hour notice of a cancellation or change in appointment time, or I will forfeit a treatment off my package since treatments are by appointment only. There are no refunds if I am responding to treatment and decide to stop treatments. Should I decide to add an Yesotherapy and or Gaia Sculpt treatment , that treatment will be considered an additional and separate treatment. This extra treatment can be paid for separately.

Cancellation Policy

If there is a need to cancel for any reason, we ask for a 24-hour notice. Please understand that when you do not cancel or show up for an appointment, it is a cost to us. If you cannot provide us with a 24-hour notice, we may impose the following fees:

“No Show” for session:

*Loss of that treatment in your treatment package

Same day cancellation:

*$50.00 charge before your next scheduled treatment

I have read and understand the cancellation policy of the service provider and agree to abide by the above conditions.

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