Enhanced B Bar
Email:
I, give my consent for body sculpting and/or facial treatments to be performedby Enhanced Body Bar, Body Sculpting and Aesthetics.
Please read and initial each of the following statements below:
I certify that I am over the age of 18.
I have voluntarily elected to receive body sculpting/facial treatments after the nature and purpose of this treatment has been explained to me.
I understand that body sculpting can be used to reduce fat deposits, but is NOT intended to be a weight loss solution.
I understand that the following conditions preclude me from having this treatment and verify that none of the following conditions apply to me at this time: • Cardiac condition(s) • Cancer • Infected, inflamed or swollen skin • Metallic implant (pacemaker) • Pregnant and/or lactating
I recognize there are no guaranteed results.
I understand and acknowledge that there are risks involved with the treatment I will be receiving including, but not limited to: • Redness • Swelling • Irritation • Skin reaction • Increased heart rate
I have been informed of possible benefits, risks and complications. I have had the opportunity to ask questions regarding these risks and other possible complications.
I have, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically.
I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. I agree I will assume the risk and full responsibility for any and all side effects, injuries, losses, or damages which might occur to me while I am undergoing the procedure(s). I do not hold the technician or Enhanced Beauty Bar, Body Sculpting and Aesthetics responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.
NAME PRINTED
CLIENT SIGNATURE
DATE