Body Contouring Intake Form

Treatment Policies

Your appointment time is reserved specifically for you. Luxe Glow Lab does not double-book appointments, and adequate time is set aside to provide each client with individualized care.

Please provide at least 24 hours’ notice if you need to cancel or reschedule your appointment. Cancellations or rescheduling requests made less than 24 hours before the scheduled appointment are subject to a $50 late-cancellation fee that must be paid before another appointment can be booked.

A no-call/no-show may result in forfeiture of one session for clients currently using a package. After a no-call/no-show, online self-booking privileges may also be restricted, and the client will need to contact Luxe Glow Lab directly to schedule future appointments.

Clients arriving more than 15 minutes late may need to have their appointment shortened or rescheduled depending on the remaining appointment time.

All sales are final. Payments, packages, and completed services are non-refundable. Packages are non-transferable. Individual results vary, and Luxe Glow Lab does not guarantee specific results from any treatment or package.

Clients are responsible for providing complete and accurate information regarding their health history, medications, allergies, recent procedures, surgeries, pregnancy status, and any changes in their medical condition before receiving services. Luxe Glow Lab may postpone or decline treatment when there is a potential contraindication or when medical clearance is appropriate.

Appropriate draping and client privacy will be maintained throughout the service. Clients may request that a treatment be stopped at any time. Luxe Glow Lab also reserves the right to discontinue a service if there is a safety concern, contraindication, inappropriate behavior, or other reason that makes continuing the treatment unsuitable.

Luxe Glow Lab provides cosmetic and wellness services and does not diagnose, treat, cure, or prevent medical conditions. Services provided by Luxe Glow Lab are not a substitute for evaluation or treatment by a licensed healthcare provider.

LUXE GLOW LAB – BODY CONTOURING CLIENT CONSENT & AGREEMENT

I understand that the services provided by Luxe Glow Lab are elective cosmetic and wellness services and are not intended to diagnose, treat, cure, or prevent any medical condition. I understand that Luxe Glow Lab does not provide medical advice and that I should consult with my physician or other qualified healthcare provider if I have questions about whether a treatment is appropriate for me.

CLIENT HEALTH INFORMATION

I certify that, to the best of my knowledge, all information I provide on my intake and consent forms is complete, truthful, and accurate.

I agree to disclose any relevant medical conditions, recent surgeries or procedures, medications, allergies, pregnancy or possible pregnancy, implanted medical devices, skin conditions, infections, or other health information that may affect my treatment.

I understand that failure to disclose relevant information may increase my risk of an adverse reaction or complication. I agree to notify Luxe Glow Lab of any changes to my health, medications, pregnancy status, or medical history before future appointments.

TREATMENT CONSENT

I voluntarily consent to the body contouring or wellness service(s) discussed with me and selected for my appointment or treatment plan.

Depending on the service selected, treatments may include techniques or equipment such as manual lymphatic drainage, wood therapy, radiofrequency, ultrasonic cavitation, vacuum therapy, laser lipo, EMS or similar non-invasive body contouring modalities.

I understand that the specific treatment used may vary based on the service booked, my goals, my health history, and my response to treatment.

I understand that I may ask questions before or during treatment and may withdraw my consent at any time before or during a service.

POSSIBLE SIDE EFFECTS & RISKS

I understand that individual responses to body contouring treatments vary.

Temporary effects may include, but are not limited to:

• Redness
• Tenderness or sensitivity
• Warmth
• Tightness
• Mild swelling
• Bruising
• Temporary soreness
• Increased urination or thirst
• Skin irritation
• Temporary numbness or tingling

I understand that products such as oils, creams, gels, or other topical products may be used during my treatment and that allergic or skin reactions are possible.

I agree to inform Luxe Glow Lab immediately if I experience unusual discomfort, burning, excessive pain, dizziness, shortness of breath, or any other unexpected reaction during treatment.

RESULTS

I understand that results vary from person to person and that no specific result, amount of inch loss, weight loss, cellulite reduction, skin tightening, or other outcome has been promised or guaranteed.

I understand that multiple sessions may be recommended and that lifestyle factors such as hydration, nutrition, activity level, hormones, medications, age, and individual body composition may affect my results.

I understand that body contouring is not a substitute for weight-loss treatment, medical care, surgery, diet, or exercise.

AFTERCARE

I understand that following recommended aftercare may help support my treatment.

Depending on the service performed, recommendations may include:

• Staying well hydrated
• Maintaining regular physical activity
• Following a balanced diet
• Limiting alcohol after treatment
• Following any treatment-specific instructions provided by Luxe Glow Lab

I understand that these recommendations are general wellness suggestions and not medical advice.

ASSUMPTION OF RISK

I understand that cosmetic and body contouring services have inherent and reasonably foreseeable risks, even when performed appropriately.

I voluntarily choose to receive the service after having the opportunity to ask questions about its nature, benefits, limitations, alternatives, and potential risks.

To the extent permitted by California law, I voluntarily assume the ordinary risks associated with the elective service I have chosen.

Nothing in this agreement is intended to release or waive rights that cannot legally be waived under California law.

PRIVACY

Information provided to Luxe Glow Lab will be treated as private and confidential and used for purposes related to my services, appointments, records, communication, and business operations.

Luxe Glow Lab will not sell my personal information.

APPOINTMENTS, PAYMENTS & CANCELLATIONS

I understand that Luxe Glow Lab’s current booking, cancellation, package, payment, and no-show policies apply to my appointments.

I understand that all sales are final and payments are non-refundable unless otherwise required by law.

Packages are non-transferable.

Results are not guaranteed.

If I cancel an appointment with less than 24 hours’ notice, a $50 late cancellation fee may apply.

If I no-call/no-show while using a package, I understand that one session from my package may be forfeited.

After a no-call/no-show, online self-booking privileges may be restricted and I may be required to contact Luxe Glow Lab directly to schedule future appointments.

ACKNOWLEDGMENT

By signing below, I acknowledge that:

I have read and understand this agreement.

I have had the opportunity to ask questions before receiving treatment.

I understand the nature and purpose of the service I am receiving.

I understand the possible risks, side effects, and limitations.

I understand that results are not guaranteed.

I have provided accurate health information and agree to notify Luxe Glow Lab of any relevant changes.

I voluntarily consent to the service being performed at this appointment or as part of the treatment plan discussed with me.

My electronic signature has the same intent as my handwritten signature.