• Dolce Vita Aesthetics — Body Lab

    Body Treatment Consent, Health Disclosure & Non-Refundable Policy
  • Date*
     - -
  •  -

  • Health & Medical Information

    Please check Yes or No:

  • Are you pregnant or breastfeeding?*
  • Do you have any known allergies or sensitivities?*
  • Are you currently taking prescription medications, blood thinners, supplements, or herbal products?*
  • Do you have a bleeding or clotting disorder or bruise easily?*
  • Do you have diabetes or difficulty healing?*
  • Do you have an autoimmune condition?*
  • Do you have any heart or circulatory conditions?*
  • Do you currently have an infection, rash, open wound, irritation, or other skin condition in the treatment area?*
  • Have you recently undergone surgery or another procedure in the treatment area?*
  • Do you have any implanted medical devices or metal implants?*
  • Have you previously experienced an adverse reaction to an aesthetic or body treatment?*
  • Is there any other medical condition, medication, or health information that may affect your treatment?*

  • Informed Consent

    I voluntarily consent to receive the body treatment identified above at Dolce Vita Aesthetics.

    I understand that the treatment, its intended purpose, expected benefits, limitations, possible risks, alternatives, and appropriate aftercare will be explained to me before treatment. I have had the opportunity to ask questions and receive answers before proceeding.

    I understand that my individual response to treatment cannot be predicted or guaranteed.

    Possible Side Effects & Risks

    Depending on the treatment performed, temporary reactions may include, but are not limited to:

    Redness, swelling, bruising, tenderness, soreness, sensitivity, itching, numbness, tingling, firmness, irritation, discomfort, or temporary changes in the appearance or sensation of the treated area.

    I understand that uncommon or unexpected reactions or complications may occur.

    I agree to contact Dolce Vita Aesthetics if I experience a concerning reaction and understand that certain symptoms may require evaluation or treatment by an appropriate medical professional.

    Results & Expectations

    I understand and acknowledge that:

    • Individual results vary from client to client.
    • No specific result or outcome has been promised or guaranteed.
    • Some treatments require multiple sessions for optimal results.
    • Additional treatments may involve additional costs.
    • Results may develop gradually.
    • Results can be influenced by my anatomy, age, lifestyle, health, treatment area, and adherence to aftercare recommendations.
    • Maintenance treatments may be recommended.
    • Before-and-after photographs or results experienced by other clients do not guarantee that I will achieve identical results.

    Client Responsibility

    I certify that the information I have provided regarding my health, medications, allergies, previous procedures, and medical history is accurate and complete to the best of my knowledge.

    I agree to notify my provider of any changes to my health, medications, pregnancy status, allergies, or recent procedures before receiving treatment.

    I understand that withholding relevant health information may increase my risk of complications.

    I agree to follow all pre-treatment and aftercare instructions provided to me.

  • Non-Refundable Treatment Policy

    I understand and agree that ALL TREATMENTS AND SERVICES PROVIDED BY DOLCE VITA AESTHETICS ARE NON-REFUNDABLE ONCE PERFORMED.

    I understand that dissatisfaction with my individual results, the degree of improvement achieved, or the recommendation for additional treatment does not automatically entitle me to a refund.

    I further acknowledge that:

    • Completed treatments are final and non-refundable.
    • Results are not guaranteed.
    • Additional treatment sessions may be necessary and may require additional payment.
    • Failure to follow recommended pre-treatment or aftercare instructions does not qualify me for a refund.
    • Prepaid services, packages, deposits, promotions, and appointments are additionally subject to Dolce Vita Aesthetics' applicable payment and cancellation policies.
  • Photography Consent (please select ONE)*

  • Final Consent & Acknowledgment

    By signing below, I acknowledge that:

    I have read and understand this entire consent form. I have had the opportunity to ask questions about my treatment. My questions have been answered to my satisfaction.

    I understand the potential risks, benefits, limitations, aftercare requirements, and financial policies associated with my treatment.

    I voluntarily choose to proceed with treatment and understand that I may withdraw my consent at any time before the treatment is performed.

    I acknowledge and agree to the Dolce Vita Aesthetics Non-Refundable Treatment Policy stated above.

    Client

  • Date*
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  • Provider

    To be completed by Dolce Vita Aesthetics.

  • Provider Date
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  • Should be Empty: