Beauty Forte Aesthetics – Fat Freezing (Cryolipolysis) and Fat Cavitation Treatment Consent Form

Beauty Forte Aesthetics – Fat Freezing (Cryolipolysis) and Fat Cavitation Treatment Consent Form

Welcome to your body sculpting journey with Beauty Forte Aesthetics. Please complete this consent form carefully before your 3D Lipoid Device treatment in Nigeria.
Welcome & Preparation Guidelines
Welcome to Beauty Forte Aesthetics! Our body sculpting treatments with the 3D Lipoid Device are designed to help you achieve your desired physique safely and effectively. Please review the following preparation guidelines before your appointment:
• Drink plenty of water before and after your treatment.
• Fast for at least 2 hours prior to your session.
• Engage in light exercise before and after your treatment.
• Monitor your food intake for optimal results.
• Avoid alcohol and high-sugar drinks before and after your session.
• Results vary for each individual and may take time to appear.
• You may experience a warm sensation or mild discomfort during treatment.
Client Personal Details
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name/Phone Number*
Medical History Screening
Are you currently pregnant or breastfeeding?*

YesNo
Do you have any cold sensitivity disorders (e.g., cryoglobulinemia, cold urticaria, Raynaud’s disease)?*

YesNo
Do you have any skin conditions or infections in the treatment area?*

YesNo
Do you have a hernia or history of hernia in the treatment area?*

YesNo
Have you had any recent surgery or medical procedures?*

YesNo
Are you currently taking any medications or supplements?*

YesNo
Have you previously undergone any fat reduction or body sculpting procedures?*

YesNo
About the 3D Lipoid Body Sculpting Treatment
The 3D Lipoid Device uses vacuum suction and controlled cooling to target and crystallize fat cells beneath the skin. Over time, your body naturally eliminates these fat cells, resulting in a more sculpted appearance without surgery.
What to Expect During Treatment
• Photographs will be taken for progress monitoring.
• The treatment area will be marked and measured.
• A gel pad will be applied for protection.
• You may feel suction and cooling or numbness during the session.
• After treatment, a gentle massage will be performed.
• Temporary redness or swelling may occur in the treated area.
Expected Results
Body sculpting is not a weight loss procedure. Visible results typically appear within 3 weeks to 3 months, and multiple sessions may be required to achieve your desired outcome.
Common Side Effects
You may experience redness, bruising, swelling, numbness, tenderness, itching, tingling, bloating, or muscle cramps in the treated area. These side effects are usually mild and resolve within a few days to weeks.
Rare Side Effects
Rarely, paradoxical adipose hyperplasia, late onset pain, hyperpigmentation, vasovagal symptoms, subcutaneous induration, or aggravation of a hernia may occur. Please inform your practitioner if you experience any unusual symptoms.
Aftercare Instructions
I understand and agree to the following aftercare instructions:*

Maintain good hydration after treatment.Engage in regular light exercise.Follow a balanced and healthy diet.Avoid alcohol and high-sugar drinks for at least 48 hours post-treatment.Contact the clinic if I experience severe or worsening symptoms.
Photography Consent
I consent to photographs being taken for medical records and progress monitoring, and allow Beauty Forte Aesthetics to use non-identifiable images for educational or promotional purposes, including social media..*

Yes, I consent.
Final Client Declaration
I confirm that I am of legal age, the information I have provided is accurate and complete, all my questions have been answered, and I voluntarily consent to undergo the body sculpting treatment.*

Yes, I confirm and consent.
Signatures
Client Signature*
Practitioner Signature*
Date*

MonthDayYear
Date
Should be Empty:

Beauty Forte Aesthetics – Fat Freezing (Cryolipolysis) and Fat Cavitation Treatment Consent Form

Welcome & Preparation Guidelines

Client Personal Details

Medical History Screening

About the 3D Lipoid Body Sculpting Treatment

What to Expect During Treatment

Expected Results

Common Side Effects

Rare Side Effects

Aftercare Instructions

Photography Consent

Final Client Declaration

Signatures