Client Release & Commitment Form
I agree to the following Conditions of my Lypossage Body Contouring Program
To keep all my Lypossage Appointments
To do the Recommended Home Care
To maintain (at least) my normal eating habits
I consent to being measured every session with the purpose of recording changes in the target area(s).
I will report any significant health issue that may occur during the Lypossage Body Contouring Program
I am aware that all files, photographs, and measurements are the property of the Lypossage Practitioner
I consent to being photographed for the purpose of recording changes of target area(s)
I give my permission for the Practitioner to publish statistics &/or photographs derived from my Lypossage Body Contouring Program
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Signature
Submit
Should be Empty: