Body Contouring Client Intake Form

Do you have any of the following?

Do you feel any pain on any part of your body? If yes, which part?
Acknowledgment
I understand that this procedure cannot guarantee 100% expected results.I understand that several treatments might be needed to achieve good results.I allow Justified by Netta LLC to take photographs of my before and after results as proof of the treatment.I allow Justified by Netta LLC to use these photographs for case studies, advertising, and marketing.I was educated that hyperpigmentation might happen temporarily as a result of treatment.I confirmed that all information in this form is accurate and true to the best of my knowledge.
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Liability Waiver
I understand that this activity might lead to personal injury therefore I release Justified by Netta LLC to any liabilities like personal injury and damage. I also authorize Justified by Netta LLC to make medical decisions for me if needed and if unable to contact an emergency contact person.
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Patient Information