lifecareforwomen.com - Emsella Consent

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Please answer whether you are currently have or have had any of the following:

If you answer YES to any of the questions, please specify below:*

Cancellation Policy

Upon scheduling, you'll be asked to provide a credit card number to guarantee your treatment,
Your credit card information will be securely stored in your history file.
To avoid cancellation fees, please cancel or reschedule at least 24 hours before your appointment.
If you cancel with less than 24 hours' notice, your credit card on file will be charged the cancellation fee of $50.
No-shows will be charged 50% of the service fee.
Monday appointments must be canceled or rescheduled by Friday.
Appointment Reminders:
We'll send you a text message reminder before your scheduled service.
It's your responsibility to manage your appointment even if the reminder system fails.
We appreciate your understanding and cooperation. Thank you for choosing Linda I. Sodoma, DO,
PLC for your service.

Policy

TREATMENT CONSIDERATIONS:
You are scheduled for a series of non-invasive treatments with the BTL EMSELLA device.

BTL EMSELLA is intended to provide entirely non-invasive electromagnetic stimulation of pelvic floor musculature for the purpose of rehabilitation of weak pelvic muscles and restoration of neuromuscular control for the treatment of urinary incontinence in women.

Your treatment provider will discuss your specific treatment needs. Recommended number of treatments is 6. The treatment is typically about 30 minutes per session, with sessions separated by at least 2 days, depending on your needs. Completing a full treatment series is necessary to maximize treatment efficacy. You may need additional treatments depending on the severity of your condition. The results will typically continue to improve over the next few weeks.

There is typically no pain associated with your treatment and there is no anesthetic required. You will experience gradually increasing tingling feeling and muscle contractions. These sensations in the pelvic area are normal and expected. You remain fully clothed during the treatment.

On the day of the treatment, you are advised to wear comfortable clothes which allow flexibility for correct positioning and increased comfort during the treatment.

Please sign here to consent to cancellation and liability information *

EMSELLA - Consent Form