Body Contouring Consultation Form

Name*

First NameLast Name
Gender*
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
Please enter a valid email.
Phone Number*
Please enter a valid phone number.
Emergency Contact*
Full Name / Phone Number
Medical History*

Cancer / ChemoDiabetesAutoimmune DiseasePhlebitiesHigh Blood PressureGastrointestinal DisorderEpilepsyCardiovascular DiseaseLiver ConditionBack / Neck PainMetal Bone PinsGallbadder RemovedThyroid ConditionSkin DiseaseTumorsN/A
Are you currently undergoing treatment for a medical condition that isn't mentioned above?*

YesNo
If yes, please specify:
Are you currently under any prescribed medications?*

YesNo
If yes, please specify:
Do you have any known allergies?*

YesNo
If yes, please specify:
Have you undergone any surgeries in the recent past, including plastic surgery?*

YesNo
If yes, please specify:
If applicable, when is your next menstrual cycle start date?*
Please notify the treatment provider if you are on/within 2 days before or after your menstrual cycle
Are you currently pregnant or trying to be pregnant?*

YesNo
Do you possess any implanted medical devices, which may include but are not limited to hearing aids, a pacemaker, or hormonal pellets?*

YesNo
If yes, please specify:
Have you ever experienced body sculpting treatments?*

YesNo
If yes, please specify:
What are your main objectives for body contouring?*

Weight loss / fat reductionCellulite reductionMuscle definition & toneSkin tightening
Do you regularly participate in exercise?*

YesNo
If yes, how often & what type:
Are you currently on a diet?*

YesNo
If yes, please specify:
Do you drink alcohol?*

YesNo
If yes, how often:
I completed the above form to the best of my knowledge. I have had the opportunity to ask any questions and have received satisfactory answers. I will inform the technician of any changes to the above information. I am over the age of 18 and consent to the procedure. If I am under the age of 18, my parent/guardian must sign below. I will not hold the technician, salon, or employees liable for any injury or damage that may occur as a result of the body sculpting procedure or for any issues not disclosed at the time of my service.*

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The body contouring procedures are performed with the proper technique, products, and instruments, and with your safety in mind. however, there still are some risks associated with the procedure. This consent form is intended to inform you of the risks of the procedure and to obtain your informed consent for the procedure.
- I understand that an allergic or adverse reaction to the body sculpting procedure can occur. The symptoms can include, but not limited to, redness, swelling, soreness or tenderness, bruising, and short term muscle ache. I understand the effects may be worse for people with sensitive skin or skin conditions.
- I agree to seek medical attention at my own expense if necessary.
- I have provided accurate information regarding my health history and agree to keep the salon informed of any new diagnoses or changes.
- I understand that results of the procedure may vary and my final result may not be what I initially envisioned.
- I understand that body sculpting is not a permanent solution, and I may require periodic maintenance sessions to maintain results.
- I've informed the salon if my appointment is within 2 days of my menstrual cycle starting or 2 days after the cycle ends (if applicable), as it may lead to increased sensitivity or discomfort.
- I agree to the home aftercare procedure recommended by the technician.
I completed the above form to the best of my knowledge. I have had the opportunity to ask any questions and have received satisfactory answers. I understand the risks and potential side effects associated with the body sculpting procedure. I am over the age of 18 and consent to the procedure. If I am under the age of 18, my parent/guardian must sign below. I will not hold the technician, salon, or employees liable for any injury or damage that may occur as a result of the body sculpting procedure or for any issues not disclosed at the time of my service. This agreement remains in effect for this procedure and any follow-up appointments.*

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Todays Date*

MonthDayYear
Date
Cancelation Policy Form

We are committed to providing all of our clients with exceptional care in a timely manner. For this reason, we have instituted a 24 hour cancellation policy for all appointments.

We understand that sometimes life gets in the way and appointments need to be rescheduled or canceled. However, we kindly ask that you provide at least 24 hours' notice if you need to cancel or reschedule your appointment. This allows us to offer the time slot to another client who may be waiting for an appointment.

If you need to cancel or reschedule within 24 hours of your appointment, a fee of 50% of the service cost will be charged. If you do not show up for your appointment and do not provide any notice, the full cost of the service will be charged.

If you are late we reserve the right to cut your service, you will be charged for the service you booked not the cut service. If you are more than 15 minutes late and we do not have enough time to perform the service due to timing, you will be charged in full.

We appreciate your understanding and cooperation in following our cancellation policy. Our goal is to provide the best possible service to all of our clients, and this policy helps us achieve that goal by ensuring that our estheticians' time is used efficiently and effectively.
I have read this policy and understand that I need to provide at least 24 hours notice when rescheduling or cancelling an appointment. If I fail to contact the office at least 24 hours in advance, I will be charged the appropriate cancellation fee.*

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Todays Date*

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Date
Photo & Video Release Form

I hereby grant permission to RB Beauty Bar and its employees to take photographs or videos of me, my likeness, and my overall appearance during my visit/appointment.

I understand that the photographs and videos may be used for promotional and marketing purposes, including but not limited to social media, website, print materials, and other forms of marketing. I understand that RB Beauty Bar has the right to edit and use these photographs and videos as they see fit.

I also understand that I will not receive any form of compensation or financial renumeration from the use of these photographs or videos.

I also understand that once the photographs or videos are used, RB Beauty Bar has no control over the use of the images by third parties, who may also use the images for their own purposes.

I release and discharge RB Beauty Bar, its owners and employees from any and all claims, demands, or causes of action that I may have against them arising out of or in connection with the use of the photographs or videos.

I hereby acknowledge that I have read and fully understand the terms of this release and that I have had the opportunity to ask any questions that I may have before signing.

By signing this release, I certify that I am at least 18 years of age. If under 18 years of age, a parent or legal guardian must sign this release.
By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.*

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Todays Date*

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Date
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Cancelation Policy Form

Photo & Video Release Form