EM-BODY SCULPT CONSENT FORM + PRE-CARE & AFTERCARE INFORMATION

Pre-Treatment Care

• Don’t be full. Avoid eating at least one hour prior to treatment.
• Drink plenty of water and stay hydrated the day before of treatment (at least 2 liters or 64 oz of water)
• Remove any metal jewelry
• Shave treatment area the night before treatment.
• Women with an IUD (intrauterine devices) may not receive eBody Tone treatments on their abdomen.

Post-Treatment

• Use ice packs (covered in clean/soft cloth) to reduce any swelling, stiffness and bruising resulting from treatment
• Apply moisturizer and sun protection to treatment area(s)
• Engage in a 15-20 minutes of light exercise, such as walking, within 6 hours post-treatment to stimulate lymphatic drainage
• Do not engage in strenuous exercise for 24 hours post-treatment. The body needs time to recover
• Drinking plenty of water and stay hydrated (at least 2 liters or 64 oz of water)
• Avoid spicy food for 24 hours post-treatment
• Avoid alcohol for 24 hours post-treatment
• Do not use a spa or sauna for 72 hours post-treatment. 

PLEASE AGREE TO THE FOLLOWING:

- You are scheduled for a series of non-invasive treatments with the Emsculpt. The device is indicated for improvement of abdominal tone, strengthening of the abdominal muscles, development of firmer abdomen. strengthening , toning and firming of buttock
- Your treatment provider will discuss your specific treatment needs. Recommended number of treatments is 4. The treatment is typically 30 minutes per session, with sessions separated by at least two days. Completing a full treatment series is necessary to maximize treatment efficacy. You may need additional treatments depending on your goals.
- Before the treatment, you are not required to do anything special, however, keeping your body well hydrated is recommended. On the day of treatment, you are advised to wear comfortable clothing which allows flexibility for correct positioning during the treatment. You will be asked to remove all metallic accessories and electronics devices
- I acknowledge that a successful treatment outcome can be affected by smoking or excessive alcohol consumption, as well as: eating disorders or on-going medication. While no special diet is required, you are encouraged to eat healthy to help promote and maintain results
- The treatment does not require anesthesia. During the application, you will feel intense muscle contractions in the treated area. The procedure doesnt require any recovery time. Typically, you can get back to your daily routine right after the treatment
- I acknowledge that the treatment should preferably be applied directly over the skin. If not, I am aware not to wear any metallic accessories (such as jewelry, watch or clothes containing metallic threads) during the treatment. I also acknowledge that I do not have metallic or electronic implants (such as pacemakers, defibrillators, metallic IUDs, etc.)

Please read and agree to the following treatment considerations:

- I am aware that the treatment cannot be applied over the head, heart and neck.
- I am aware that pregnancy and nursing are contraindicated, and pregnant women cannot undergo the treatment.
- I understand that there are certain risks associated with Emsculpt treatments and they include but are not limited to muscular pain, temporary muscle spasm, temporary joint or tendon pain, local erythema or skin redness and intramuscular fat decreases.
- I understand that the treatment over injured or otherwise impaored muscles is contraindicated
- I understand that the treatment may involve risks of complications or injury from both known and unknown causes, and I freely assume these risks.
- I agree to before and after treatment photographs, measurements and weighing, as this will help for medical evaluation of the result of the treatment. Information will be acquired for medical records or marketing purposes.
- I understand the results may vary from person to person and that anexact result cannot be predicated. Completing a full treatment series is necessary to maximize treatment efficacy. It is very unlikely, but it is possible that you will not feel any recognizable results after the procedure. I acknowledge the results may not meet my expectations.
- I certify that I have read this entire document and that I agree with all provisions. I certify that I have had the opportunity to ask questions and these questions have been answered in full to my satisfaction. I fully understand the treatment conditions, the procedure, and possible side effects.
- I have read the above information, and I request and give my consent to be treated with the Emsculpt by the practitioner in this practice and her designated staff.

I have read and agree to the treatment considerations above.

No I am not 18 years old. I have parental and/or guardians consent with a signature. By signing below you understand all of the possible risks of this service.