Non-invasive Brazilian Butt Lift Consent Form

VACUUM THERAPY BRAZILIAN BUTT LIFT TREATMENT CONSENT FORM

What you can expect?
• Vacuum Therapy is a painless procedure, after treatment mild redness may appear
occasionally but will fade quickly and be highly unlikely to cause any actual pain.
• During the application, you may feel a minor pinching sensation when cups are
being applied or removed. This should be tolerable and not painful.
• Treatment applicator may feel heating or cooling from the applicator as it pulses
and is usually tolerable.
• The area may feel slightly tender immediately after the procedure.
• The treated area may occasionally be flushed, red and feel tingly. In rare
circumstances mild bruising my occur.
• The procedure doesn’t require any recovery time. Typically, you can get back to
your daily routine right after the treatment.

Before and Aftercare
Before the treatment, you are not required to do anything special, however, keeping your body well hydrated is strongly recommended.

On the day of the treatment, you are advised to wear comfortable clothing, allowing
flexibility for correct positioning during the treatment. You will be asked to remove all
metallic accessories and electronic devices. While no special diet is required, you are
encouraged to eat healthy to help promote and maintain results.
Vacuum BBL treatments do not require a lot of preparation. These treatments are
increasingly popular as there is no complex post treatment plan.

After the session, clients should resume normal activities and drink plenty of water. Clients are also encouraged to drink plenty of water and stay hydrated throughout the
entire treatment process. Keeping the body well hydrated before the treatment is
recommended to reduce cramping.

How many treatments?
Typically 2 – 4 sessions for best results and they should be done within a 1 –2 week span.
Once the initial treatments are done, maintenance treatments monthly or every second month are recommended.
During your consultation, our specialist will work with you to develop a tailored treatment plan, to achieve the best possible results for your concerns.
We will use our experience and expertise to be able to provide you with the closest guide possible when advising the number of sessions required.

Please note, results will vary client to client due to age, lifestyle, condition of the skin and stubbornness of the concern, so more than the recommended amount of sessions may be required. Some clients see results a lot quicker than others however this again will vary person to person. Non-Surgical Body Contouring is a process and we are with you the whole way. Please be patient, we are just as excited about seeing the results as you are.

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Gender

MaleFemale

Marital Status

SingleMarriedWidowedDivorced

Date of Birth

Date

Age

Contact In Case Of Emergency

Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Relationship

Medical History

	Yes	No
Are you pregnant or nursing?
Are you immunocompromised?
Do you have any liver or kidney disorders?
Do you have any thyroid gland dysfunction?
Do you have epilepsy?
Do you have cancer or a history of cancer?
Do you have photosensitivity to sun exposure?
Are you taking any drugs that may cause photosensitivity?
Have you undergone an organ transplant?
Do you have any current infections?
Do you have advanced untreated diabetes?
Do you have uncontrolled Hypertension?
Do you have any kind of heart condition?
Do you have hemophilia (blood clotting condition)?
Do you have a keloid scar?
Do you have any infectious disease or tuberculosis?
Do you have a pacemaker?
Chemical peels: Have you ever has a chemical peel?
Are you using any products containing Retinol, Retin A, Glycolic Acid on the area being treated?
Have you had a chemical peel on the area to be treated in the last 5 weeks?
Do you have any allergies?

If you have answered 'Yes' to any of the medical conditions above, we advise you to see your doctor first before undergoing treatment with us. We reserve the right to not begin any treatment should we believe that such treatment may cause risk to our client due to the medical conditions which the client has.

Reminder:

Please make sure that there are no metal instruments that are present on or in your body during the scheduled treatments. If you have any heart or liver problems, uncontrolled high blood pressure, or cancer or undergoing radiology treatments, please see your doctor first. However, if you have a pacemaker, it is unfortunate that we cannot proeed with any of the services that we offer.

CONSENT

I hereby declare that I am of legal age and I understand that treatments for body sculpting and facials do not guarantee absolute results. In order to achieve my desired results, I may be required to undergo several treatments with an appropriate diet and physical activity for body sculpting or specific skin care routine in the case of facials and chemical peels. I understand that non-invasive procedures do not rid the body of visceral fat.

I hereby release and forever discharge Snatched Up Body Sculpting, LLC, its affiliates, partners, agents, and employees from any and all causes of action. I will hold harmless, Snatched Up Body Sculpting, LLC for any liabilities, damages, injuries whether seen or unforeseen.

I understand pictures may be taken for clinical records. If pictures are used for education or marketing purposes, all identifying marks will be cropped or removed. Initials:

I understand that any procedure under Snatched Up Body Sculpting, LLC does not constitute medical treatment or cure to any illness.

By signing this form, I declare that all information and declarations I have made above are true and correct to the best of my knowledge. I have had the opportunity to ask questions and which were answered to me and to my satisfaction. I have likewise read all the information above and give my consent with my full knowledge, understanding, and assumption to the risks involved in the treatment, without any coercion, inducement, or undue influence.

Signature

Date

Consent Form for Non-invasive BBL