CLIENT PROFILE AND MEDICAL HISTORY

Have you consumed at least 3 glasses of water today prior to treatment?Yes

By signing below, I verify that I am in good physical condition and the information documented is accurate and complete. have no physical restriction. condition, or disability which may prevent me from receiving the prescribed skin care and/or body treatment therapies. I hereby give my consent to have the recommended procedures performed on me.

Informed Consent for Non-Surgical Body Contouring Treatment

I understand that certain procedure(s) elected are relatively new and little is known about their long-term safety and effectiveness. I understand that each person has a different response to Body Contouring.

Iunderstand that the procedure(s) do not correct health problems, including but NOT limited to diabetes, heart attack, stroke, high cholesterol, blood clots, lung problems, stomach, intestinal problems, bladder disease, an abnormality of the skin. Fancy Curves N' More is NOT a medical facility and does NOT make medical decisions. You must consult with your Primary Care Physician for medical advice.

I understand that I may need post procedure carc. I will dutifully be responsible and compliant with the recommendations from my Fancy Curves N' More Clinician, which may include, but are not limited to skin care products, garments, etc.

I understand that procedures involve risk. Risk may include, but not limited to redness, swelling, irritation, burns, skin reactions, etc. I must immediately report any unusual symptoms known to me to my Fancy Curves N' More Clinician that includes, but NOT limited to being aware of any slight nature or prominence of persistent chills, fever, redness, increased warmth, excessive bruising or swelling, etc. at the sites treated and systemically.

I give Fancy Curves N' More permission to use data about my treatment for research purposes. I understand that my name and personal identifying information will remain confidential unless I have written permission to disclose this information. I give Fancy Curves N' More professional permission to photograph/vidco my procedure(s I have decided that the benefits of body contouring outweigh the potential for complications and all claims have not been evaluated by any regulatory board. I understand the nature of the procedure(s) and ANY and all possible risks mentioned and not limited to. I attest that I am of clear mind, competent, and not under any distress.

ALTERNATIVE TREATMENTS

It has been explained that other temporary and more permanent treatments are available to sculpt, contour, tone, exfoliate, clean and detoxify the body. Alternative forms of management include receiving NO treatment at all. If treatment is chosen alternative body sculpting therapies and other services offered include the following: Lipo Laser, Ultrasound Cavitation, Vacuum Therapy, Electrotherapy, Vibration, Cold/Hot Wraps, Infrared Rays, Reduction Massage, Lymphatic Drainage, Buttocks & Breast enhancement, Wood Therapy, HIFU Vaginal Tightening, Topical Skin Therapies i.e., gels, creams, oils, etc. I understand that risk and potential complications are associated with these alternative forms of non-surgical treatments.

CANCELLATION POLICY

If there is a need to cancel for any reason, we ask for a 24-hour notice. "Late cancels" and/or "No Shows" WILL result in the loss of deposit amount of service, and will be deducted from prepaid service package if applicable. (Initial)

TIME LIMITS FOR SERVICE

Specials, Flash Sales & Promotional Priced Services MUST BE completed within 30 days of purchase date. 

Regular Price Services MUST BE completed within 60 days of purchase date.

RELEASE OF LIABILITY

I herein certify that I am not pregnant or nursing.

Iunderstand that NO GUARANTEES OR WARRANTIES have been made to me regarding the outcome or any improvements to my condition due to the procedure(s) I have elected to undergo. I am paying for a service and not desired results from treatments. I have been given the opportunity to ask questions and have received satisfactory answers to those questions by the treating staff representative.

I consent to the taking of photographs/video for documentation during my treatment(s) unless otherwise stated
with written notice to Fancy Curves N’ More. These photos may be used for marketing and/or publication for
the further benefit of educating the public. All attempts will be made to protect my identity.

I agree to indemnify, hold harmless and release Fancy Curves N’ More its employees, members, representatives,
affiliated organizations, and others acting on the Company's behalf of all claims, demands, causes of action and
legal liability, whether the same be known or unknown, anticipated or unanticipated. I further agree that in except
in the events of the Company's gross negligence or willful misconduct, no claims, demands, legal actions and
causes of action shall be made against the Company for any economic and non-economic losses of any kind.

Finally, I certify that I have read and fully understand the contents of this form and that the disclosures referred to
the above were made prior to my signing the form below.

NO REFUND OR RETURN POLICY. ALL SALES ARE FINAL.

I ACKNOWLEDGE THAT I HAVE HAD A FAIR OPPORTUNITY TO ASK QUESTIONS ABOUT
FANCY CURVES N’ MORE PROCEDURES FOR BODY CONTOURING AND THE ALTERNATIVE
TREATMENTS AVAILABLE. I ALSO ACKNOWLEDGE THAT MY QUESTIONS HAVE BEEN
ANSWERED TO MY SATISFACTION. I UNDERSTAND AND ACCEPT THE POTENTIAL RISKS
AND COMPLICATIONS INVOLVED.