Body Contouring Consent Form

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Date of Birth

Date

Gender

Are you pregnant

Are you breastfeeding

Have you had surgery last 6 months

Do you have any of the following: eczema, psoriasis, dermatitis, or active rashes which can interfere with the treatment and lead to irritation or complications.

Do you have any heart condition or pace makers?

Have you ever had skin cancer?

Any blood disorders/ poor circulation?

Do you have any of the following : epilepsy, multiple sclerosis, or nerve disorders. They should avoid treatments that involve electrical or electromagnetic stimulation.

Do you have a autoimmune disease ? If you have autoimmune disorders (like lupus or rheumatoid arthritis) You may not be able to receive body contouring.

You can't be on birth control, your period, no medications, or rosacea.

You have to drink 1.5-2 liters off water, no alcohol, no caffeine before and after, no food for 1 hour before.

I acknowledge that:

Further, I acknowledge that:

Stay Hydrated: Drink plenty of water after the treatment to help flush out toxins and support the body’s natural processes in eliminating fat cells.Avoid Heat: Avoid hot showers, saunas, or hot tubs for 24-48 hours after the treatment, as excessive heat can interfere with the process and cause inflammation.Light Exercise: Gentle exercise, like walking, can help stimulate lymphatic drainage and improve circulation. However, avoid intense workouts for 48 hours post-treatment.Massage: Some treatments may require post-procedure massage to stimulate lymphatic drainage and promote fat breakdown. Your practitioner may suggest a massage or gentle self-massage to help with the process.Avoid Alcohol and Caffeine: Alcohol and excessive caffeine can dehydrate your body, which may hinder the results, so it’s best to avoid these for at least 24 hours after the treatment.Wear Compression Garments (if recommended): For some treatments, such as cavitation, wearing compression garments can help reduce swelling and support skin tightening.Follow a Healthy Diet: Maintaining a healthy, balanced diet can optimize results. Avoid overeating or consuming processed foods, which could counteract the effects of body contouring.Avoid Tight Clothing: Avoid wearing tight or restrictive clothing around the treated areas for a few days to prevent irritation or discomfort.Manage Swelling and Bruising: Mild swelling or bruising is common after some body contouring procedures. Applying cold compresses or taking anti-inflammatory medications (if recommended by your practitioner) can help reduce swelling.No Massages or Scrubbing: After certain body contouring treatments, avoid aggressive scrubbing, exfoliating, or receiving deep tissue massages for a few days to avoid irritation.Avoid Direct Sun Exposure: Keep the treated areas out of direct sunlight, and avoid tanning beds for at least a few weeks. If you must go outside, wear sunscreen to protect your skin.Follow-Up Appointments: Depending on the procedure, follow-up treatments may be necessary to achieve optimal results. please write I agree

By signing this form, I declare that I am of legal age and give my full consent to the Body Contouring treatment. I have fully read and understand the contents provided herein and I assume the risks involved, including any complications and benefits resulting from the foregoing. I have had the opportunity to ask questions and clarifications and by which I have received answers to my satisfaction. I am executing this consent with full knowledge and responsibility to my actions.

Signature of Legal Guardian/Representative

Date Signed

Date

Required Deposit for Service

USDMinimum Deposit

Payment Methods

Credit Card

Apple Pay