Informed Consent For Body Contouring

give my consent for body contouring to be performed by The Glamour Dungeon.

Please read each of the statements below:

I certify I am over the age of 18.

I have voluntarily elected to receive body contouring after the nature and purpose of this

treatment has been explained to me.

I understand that the following conditions preclude me from having this treatment at this time and verify that none of the following conditions apply to me at this time:

• Cardiac issues
• Cancer
• Infected, inflamed, or swollen skin
• Metallic implant (pacemaker)
• Pregnant or Lactating

I recognize there are no guaranteed results.

I understand and acknowledge that there are risks involved with the treatment I will be

• receiving including, but not limited to:
• Redness
• Swelling
• Irritation
• Skin reaction
• Increased heart rate

Including all known allergies or prescription drugs or products I am currently ingesting or using topically.

I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. I agree I will assume the risk and full responsibility for any and all injuries, losses, side effects, or damages which might occur to me while I am undergoing this procedure. I do not hold the technician responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.