Polished

Body Contouring
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24 hour cancellation notice is required otherwise there will be a no show fee. Package pricing is non-refundable/non-transferable/30 DAY EXPIRATION.

Lipo-Laser is one of the tools that we can use to help you reach your goals and target specific areas of your body. Once the fat cell is broken down, the lymphatic system transports the free fatty acids and glycerol to the liver for processing to be used as an energy source for your body. It is critical that the dietary and lifestyle changes are made to help support the goals of treatment.

A reduced calorie diet and an exercise program that will help burn 350 - 500 calories post treatment are ideal. Individual results may vary and it is the responsibility of the patient too ensure they are doing the appropriate healthy lifestyle changes to ensure maximum results. Chiropractic adjustments are required to help stimulate and support lymphatic drainage to clear the free fatty acids and glycerol from your system. Supplements may be provided to block the absorption of free fatty acids and glycerol by the cells prior to either being used as an energy source or excreted out the urinary tract. Most patients report 1/2 inch reduction with each treatment and multiple inches can be lost with a series of treatments.
I consent to taking photographs for progress charting (Initial)
I confirm the following:
Limitation to Treatment
I have been informed and I understand the temporary hyperpigmentation / hypo-pigmentation on rare occasion may occur as a result of treatment. I consent to POLISHED LIFESTYLES LLC to perform the procedure for the initials purpose of aesthetic body contouring (initial)
I understand that the first step to a positive change is creating awareness about the steps necessary to reach these goals, and will work diligently to ensure success. I understand that much of the success of the program will depend on my efforts and that there are no guarantees or assurances that the program will be successful. I realize there may be pre-existing medical conditions that can preclude me from seeing optimal results. By signing this agreement I release the spa/clinic, manufacturer and distributors from any liability regarding this treatment and do so understanding that results can vary from one individual to the next.

I have read and fully understand this consent form and | realize I should not sign this form if all items have not been explained to me. My questions have been answered to my complete satisfaction. I have been urged and have been given all the time I need to read and understand this form. If you have any questions regarding the risks or hazards of the proposed treatment, or any questions what so ever concerning the proposed treatment or other possible treatments, ask your doctor now before signing this consent form.

I understand that there are no refunds on this procedure, as well as any packages I purchase. I also understand that canceling an appointment/ rescheduling will set back my results.
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PATIENT CONSENT FOR TREATMENT
This is an important decision towards improving your wellness and overall lifestyle! We share the mutual desire of you reaching all of your wellness goals involving the LipoLaser. In order for you to reach these goals, we have provided a few points to educate you on achieving your best results. It is important to manage your expectations according to an appropriate diet, lifestyle and exercise program incorporated in conjunction with your Lipo Laser treatment protocol.

Drink plenty of water before and after treatment(s) Don't eat 2 to 4 hours prior to treatment(s) Perform physical activity following each treatment to maximize your results Manage caloric intake; excess calories will counteract the laser treatments Alcoholic beverages and high sugar content drinks must be avoided before and after

My signature herein constitutes my acknowledgment that I am a competent, consenting adult of at least 18 years of age(o my parent or legal guardian is giving consent on my behalf), and further, that I:

Have read and understand the information provided in this form

Have had my procedure adequately explained to me by my clinician Understand that light bruising is normal and will go away within a few days

Have had the opportunity to ask questions, and all of my questions

have been answered to my satisfaction

Have received all of the information I desire concerning my procedure

Understand all post treatment recommendations and agree to adhere to them

Freely assume any risks of complications or injury from known or unknown causes associated with, relating to, or otherwise arising out of this procedure

Have the right to consent to or refuse any proposed procedure at any time prior to its performance

Must notify the clinician if my medical history changes prior to subsequent treatments

I Consent to photographs of the treatment area

consent too, and authorize POLISHED LIFESTYLES LLC to perform

the laser treatment for the area of the body.
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*Do not schedule Non-Surgical Lipo or RF Skin Tightening treatment during your cycle* (cycle will become heavy)
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Body Contouring