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Client Form
Full Name
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First Name
Last Name
Phone Number
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-
Area Code
Phone Number
E-mail
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example@example.com
Sex
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Female
Male
Are you under the age 18 or over the age 65?
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Yes
No
Medical history: Check all that apply (past & present)
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Epilepsy
Cancer
Kidney/Liver disease
Inflammation or Keloids
Eczema or Psoriasis
Internal bleeding (ulcers)
Currently pregnant or nursing
Parkinsons or multiple sclerosis
Deep vein thrombosis or Varicose veins
Cardiac/Vascular problems (pacemaker)
Vertigo or Sensitivity to high pitched noises
Hypertension, Hyperglycemia, or Hyperlipidemia
None of the above
Do you have any chronic medical conditions we should know about?
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Yes
No
If so, please list below.
Have you given birth or had any surgeries in the last 90 days?
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Yes
No
Are you taking any anticoagulants?
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Yes
No
Are you recovering from any illness or injury?
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Yes
No
Do you have a metal rod, artificial joint, or any surgical implants?
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Yes
No
Do you have a difficult time breaking a sweat?
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Yes
No
Do you struggle with loose skin?
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Yes
No
What would you like to achieve from this appointment?
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Please Select
Cellulite removal
General weight loss
Slimming/Firming
Booty enhancement
Other
How did you hear about us?
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Instagram
Tiktok
Business Card
Friend
Other
Do you grant permission to use before and after procedure pictures for any advertising, education, or other use?
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Yes
No
Medical History Policy All clients will be required to complete a consent form prior to their first appointment. Any change to your circumstances, either your personal details or medical history must be advised to our staff prior to any appointment. It is the client’s responsibility to disclose all medical issues to Bodied By Tay. Bodied By Tay can not be held liable for any unknown or undisclosed medical issues. Cancellation and Reschedulling Policy To ensure you get your full treatment we require you to arrive 15 minutes prior to your appointment time. If you are late, we may not be able to provide your full treatment. Any adjustment made to your treatment time due to late arrival will result in your being charged for the full appointment. In the event we are unable to perform your treatment due to late arrival you will be required to pay for the full treatment. In the case of prepaid treatments (packages), the treatment will be forfeited. Refund Policy Bodied By Tay does not provide refunds for products or services as a result of change of mind. This does not exclude your rights for a refund under consumer law where there is a major problem with the product or service. Payment Policy At the time of making your appointment, we require a $25 non-refundable deposit to be paid to secure your booking. We require a minimum of 24 hours notice for any appointment cancellation, if you cancel less than 24 hours before your appointment you will be considered a No-Show and will still be charged for the service. If you fail to follow this cancellation policy you will also lose your deposit and be blocked from booking again. If the appointment is rescheduled a minimum 24 hours prior to your appointment day, this deposit will be applied to the scheduled appointment. If you fail to reschedule your appointment with a minimum 24 hours notice, no transfer of the deposit will be applied. In the case of pre paid treatments, the treatment will be forfeited if we are not given 24 hours notice. Payment will be made to the Business via cash or Zelle ONLY. Please bring the exact amount as change may not be available .Promotions Policy These terms and conditions will apply to all sales and promotions advertised by Bodied By Tay. Any additional terms and conditions relating to specific promotions will be available in clinic.• Promotions can not be used in conjunction with any other offer.• Promotions apply only to full priced treatments.• Promotions are not refundable or transferable between clinics or clients.• Packages are not able to be split between clients or used at any other clinic other than the clinic which it was purchased at.• Treatment packages are not able to be altered.• Promotional pricing will only apply to new bookings made and paid for during the promotion period. Promotional pricing will not apply to bookings already made.• Promotions are for a limited time and are subject to availability. Bodied By Tay may end a promotion at any time without prior notice.• Bodied By Tay has the right to refuse treatment of any client in circumstances where the therapist deems the treatment to be unsuitable.Treatment Packages Policy• All packages are valid for use for 12 months from the date of purchase.• Any treatments not used within a 12 month period will be forfeited without refund.ConcernsI understand that results from treatments may take up to 12 weeks to show results and results will vary from client to client. If you are dissatisfied with your results or experience an adverse reaction you agree to provide us with any information requested by us so we can assess your issues, this includes the provision of photographs. If you refuse our request for information it will impact our ability to assist you. Coronavirus (COVID-19) PolicyDue to coronavirus, clients are required to do the following:• All clients are required to wear a mask• No Extra Guests allowed (unless approved by Bodied By Tay)• Sanitation and temperature check required prior to starting treatment • Bodied By Tay has the right to refuse service to anyone with signs of allergies or sickness Acknowledgement & Waiver 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 Bodied By Tay. I further agree to provide Bodied By Tay 24- hour notice of a cancellation or change in appointment time, or I will forfeit a treatment of my package. I also acknowledge that failure to comply with same-day cancellation policy may result in charges on the provided debit or credit card. There are no refunds if I am unsatisfied with my results as a result of failure to comply with pre and post treatment instructions or if I decide to stop treatments and gain weight back. Should I decide to add a treatment, that treatment will be considered an additional and separate treatment.I understand that as a client you are required to follow pre-treatment and post-treatment instructions. If I fail to follow instructions I am not guaranteed to see results. I also understand that Bodied By Tay is not obligated to respond to clients who have failed to comply with instructionsI understand that if any of my medical information changes I am obligated to immediately notify Bodied By Tay. I understand that I am using 5 in 1 40k Slim Machine, Vacuum Cupping Machine and Laser Lipo Machine provided by Bodied By Tay at my own risk. Should I sustain an injury while using the equipment, I agree to not hold Bodied by Tay responsible.I understand that failure to comply with safety regulations may result in cancellation of appointment, this includes a full service charge and inability to book with Bodied By Tay in the future.I acknowledge that I am a qualifying client for this treatment and agree to all of the terms and conditions stated in this contract.I give permission to Bodied By Tay to charge my credit/debit card the full service fee if I do not show up to my appointment and/or reschedule out of Bodied By Tay's policy. I also understand I will not be able to book further appointments with Bodied By Tay. I understand that in order to receive treatment I must be over the age of eighteen and under the age sixty five.MODIFICATION OF TERMSBodied By Tay may at any time amend, modify or supplement any terms and conditions applicable to the Site, and Your continued use of the Site will constitute Your acceptance of any such amendment, modification, or supplementation.I acknowledge that it is my responsibility to fill out the client form and failure to do so is a risk. I understand Bodied By Tay is not responsible for any current or future injury or damages treatment may cause.By agreeing to these terms, I acknowledge that I have read and understand the risks associated with treatment and understand the policies I am agreeing to.
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