Body Sculpt Consent

Allora Beauty Bar

Booty/Body Sculpting Consent Form
This form is for the following body sculpting methods and services:

Methods: Vacuum Therapy, Ulstasonic Cavitation, Radio Frequency Therapy and Cryotherapy.

Services: (Booty Sculpting, Tummy/Back Detox, Cellulite Reduction, Fat Reduction and Fat Freezing)
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about Allora Beauty Bar?
Have you had body sculpting done before?
Medical Background
Do you bruise easily?
Do you have any allergies? If yes please explain
Any current medications (topical or oral)?
Current skin and/or medical conditions? If yes please explain
Any past skin and/or medical conditions we should know about?
Have you had any major surgeries? If yes please explain
Please select the boxes that apply to you:

Pregnant or nursingEpilepticCancer within the last 12 monthsCardiovascular conditionsRecent injuryHistory of internal bleedingThyroid conditionsKidney or liver conditionsMetal devices/implants (not including IUD)Other
Describe your current lifestyle. Do you currently workout/exercise at all? How much water are you drinking daily? Do you have a strict diet? There is no wrong answer here. *
Terms & Conditions
A series of treatments (5-12) are recommended per area. Some individuals may require more treatments to achieve maximum results. There should be 2-4 days between each treatment per treated area. To receive the best results it is encouraged to maintain a healthy lifestyle, this includes but is not limited to: proper nutrition, exercise, and drinking at least 8 cups of water daily. You must avoid sugar and alcohol two days before and after treatment/session for best results.*

I accept and agree to the terms and conditions listed above.
Body sculpting treatments should not be performed if you are pregnant, nursing, have a lymphatic disorder, acute illness, metal implants, pacemakers, or are currently being treated for active cancer. Body sculpting treatments should not be performed during a menstrual cycle (besides booty sculpting)*

I accept and agree to the terms and conditions listed above.
Post-treatment potential and temporary reactions include: redness, itching, bruising, swelling, numbness, cup marks and skin sensitivity. It is recommended to complete a treatment 1-2 weeks before an event.*

I accept and agree to the terms and conditions listed above.
By executing this form, I agree that Allora Beauty Bar will perform body sculpting treatment on me. I understand and acknowledge that payments I have made for any body sculpting service is non-refundable. I agree that this treatment is a process and subsequent visits may be necessary in order to achieve the desired results. I confirm that I have read through Allora Beauty Bar's website as it relates to what is involved, and how many sessions are required for better results. I understand the potential side effects and have read the aftercare recommendation. By signing this consent form I understand the benefits and risks of this treatment and have disclosed my medial history truthfully. I do not hold Allora Beauty Bar liable for any of the above side effects during or after this procedure.*

I accept and agree to the terms and conditions listen above.
Signature*

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Allora Beauty Bar

Medical Background

Terms & Conditions