Body Sculpting Consent Form

Contraindications/Disqualifications

• Pregnant (3 months after Birth, 6 months after C Section)
• Breastfeeding
• HIV/AIDS
• Cancer (all forms)
• Undergoing chemotherapy or immunetherapy
• Immunodeficiency
• Lupus
• High blood pressure (uncontrolled)
• Diabetes (uncontrolled)
• Heart problems or diseases
• Hypertension (high blood pressure treated with medication)
• Kidney damage, disease or problems
• Liver damage, diseases or problems
• Haemorrhagic disease, trauma or bleeding
• Active impanted device such as a pacemaker or defibrillator
• Under 18 years of age
• Recent surgery (must wait minimum of 6 months)
• Recent scars (must wait minimum of 6 months)
• Open wounds
• Skin diseases (avoid area)
• Infection (avoid area)
• Antibiotics (wait until course completed)
• Inflammation (avoid area)
• Varicose veins (avoid area)
• Prosthesis/silicone implants (avoid area)
• Metal implants/screws (avoid area)
• Menstrual period (wait until cycle ends)
• Metal contraceptive coil (avoid area)
• Depilatory (hair remover) creams (wait 2 weeks)
• Areas treated with IPL or laser (wait 2 weeks)
• Areas treated with Botox (3 months) or dermal fillers (wait 2 weeks)
• Suntan (sun must be avoided the entire duration of the treatment regime)
• Numb or insensitive to heat
• Rosascea
• Transplant Anti-Rejection Drugs
• Acute fever
• Chronic inflammation (depending on severity of chronic inflammatory conditions - consider that treament will increase inflammation and anti-inflammatory medications reduce the effectiveness of the treatment - please discuss with your doctor first
• Conditions that require a doctor's note to confirm the treatment is suitable before treatments can begin:
  • Epilepsy
  • Thyroid disease
  • Heart disease
  • Hypertenion (high blood pressure treated with medication)
  • Cancer - after 12 months

Body/Face Sculpting Pre-Care Instructions

Avoid eating 1 hour before and after treatment sessions
Avoid heavy meals on treatment days
No fruits or anything with sugar
No alcoholic beverages for 2 days
Drink 2 liters of water 2 hours before your appointment

Body Sculpting Treatment Dress Code

Black undergarments. We recommend wearing light, comfortable clothing such as yoga or workout clothes

Examples: Sports bra, leggings, shorts

Body/Face Sculpting Post-Care Instructions

4-6 hours after treatment, perform 30-45 minutes of cardiovascular exercise in order to create the energy demand that will facilitate metabolism of the fatty acids and glycerol freed from the fat cells
Stagger 2 liters of water intake of 24 hours for 3 days post treatment to help facilitate lymphatic drainage
Avoid fasting or the body will go into "starvation mode" and become more resistant to the release of stored fat
Possible Side Effects

Diarrhea: When fat is successfully broken down, it must exit the body as stool. You may or may not notice an increase in bowel movements. Typically diarrhea is mild and lasts no more than 36 hours
Increased Urination: Loss of water from your tissues is normal following procedures and is a good sign that you are removing fat from your body. Fat enter the blood from the lympathic system, increasing the "thickness" of the blood (oncotic pressure), and pulling water from the tissues to carry the fat to the bowel for removal
Increased Hunger: This is the body's attempt at returning to normal by re-accumulating fat. Do not increase food consumption! Follow a low carb, high protein, high fiber to diet to combat hunger pains
Bruising: Possibly bruising from the treatments
Soreness: From the pressure of the treatment, everyone's body reacts differently

By signing the below I acknowledge that I have read the Pre-Care/Post-Care instructions and Contraindictions/Disqualification List.

I confirm that I have completed the form truthfully and to the best of my knowledge/abilities.

Body Sculpting Overview
Body sculpting enhances both the lymphatic and circulatory systems while aiding in tissue cleansing. The primary benefits of these treatments include inch loss, cellulite reduction, and skin tightening.

Benefits

• Lose 1-3 inches per session with state-of-the-art equipment.
• Results may be immediate but can vary from person to person.

For Best Results

• A series of 6-15 sessions per targeted area is recommended, though some individuals may require more for optimal results.
• Sessions should be spaced 3-7 days apart.
• This is not a weight-loss treatment but an inch-loss treatment. Maintaining results requires healthy habits.
• For maximum effectiveness:
  • Eat a balanced diet and stay active.
  • Drink at least 8 glasses of water daily.
  • Exercise within 4-6 hours after treatment.
  • Avoid sugar and alcohol for 24 hours post-treatment.

Precautions
Body sculpting treatments are not recommended for individuals who are:
❌ Pregnant or breastfeeding
❌ Diagnosed with a lymphatic disorder or acute illness
❌ Having metal implants or pacemakers
❌ Currently undergoing treatment for active cancer

Client Acknowledgment & Agreement
I acknowledge that I have read and fully understand the information provided regarding body sculpting treatments, including the benefits, best practices, and precautions. I understand that body sculpting is not a weight-loss treatment but an inch-loss treatment, and results vary based on individual factors and lifestyle choices.

I understand that maintaining results requires healthy eating habits, proper hydration, and regular physical activity. I agree to follow the recommended aftercare guidelines, including drinking at least 8 glasses of water daily, engaging in light movement immediately after treatment, and performing moderate to high-intensity exercise within 4-6 hoursfor optimal results.

I confirm that I do not have any of the listed contraindications, including pregnancy, breastfeeding, lymphatic disorders, metal implants, pacemakers, or active cancer treatment. I voluntarily choose to undergo this treatment and assume all responsibility for my results.

Cancellation, Rescheduling & Refund Policy
I understand and acknowledge that payments for body sculpting services are non-refundable. If I have purchased a treatment package, I understand that there are no refunds, even if I choose to discontinue treatments while responding to them.

I agree to provide a minimum of 24-hour notice for any cancellation or rescheduling of my appointment.

By my signature below, I certify that I have read and understand the contents of this Consent Form for Body Contouring.

At Heavenly Body Curves, all appointments are by appointment only. To provide the best service to all clients, we enforce the following cancellation and rescheduling policy:

• A minimum of 24-hour notice is required for cancellation or rescheduling of any appointment.
• If a client fails to provide 24-hour notice, one session will be forfeited from their package or a $25 cancellation fee will apply for single-session appointments.
• No-shows or late cancellations may impact future booking privileges.
• Payments are non-refundable, including package sessions, even if the client chooses to discontinue treatments while responding to them.

By booking an appointment, you acknowledge and agree to this policy.