Body Contouring/Sculpting

I agree to let Laser Flavor and Flavor Beauty Bar LLC take treatment site photos/videos to keep track of progress, and for promotional/ social media purposes. I hereby grant permission to use my photos and/or videos taken of me in publications, new releases, online, and in other communications related to the business 

 

By signing this form, I acknowledge the terms and conditions of the business 

(no explicit photos will be posted).

You've been advised that the treatment is the Butt and Breast Enhancement using Vacuum Therapy Technology, of the risks involved and any alternative treatments that are available for your consideration and will be given the opportunity to ask questions. By executing this form, you agree that Flavor Beauty Bar LCC will perform the Breast and Butt Enhancement on you during treatment. Also, you have been informed of the breast and butt lift enhancement, and how many sessions are required for best results.

• The Butt and Breast Enhancement procedure is FDA cleared, patented procedure for buttocks and fatty breast tissue fat reduction using vacuum pressure to draw fatty tissue into a suction. The suction pressure may cause sensations of deep pulling, tugging and pinching. You also may experience intense stinging, tingling, aching or cramping as the treatment begins. These sensations generally subside as the are becomes numb. I understand that some of the body areas that the treatment is performed on may be considered "off label" which include posterior bra line and arms (triceps). I understand that there are other cosmetic surgical options that are available to me, but I choose the Breast and Butt Enhancement treatment.
• The procedure is for spot reduction of fat. It is not a weight loss solution and it does not replace traditional methods such as liposuction. Someone who is overweight can expect to see less visible improvement than someone who has small fat deposits. Visible results will vary from person to person.
• Immediately after the procedure, the treated area may look or feel stiff and transient blanching (temporary whitening or redness of the skin) may occur. You may feel a sense of nausea or dizziness as your body naturally warms and sensation returns to your treatment area. These are all normal reactions that typically resolve within minutes.
• Bruising, swelling, tenderness, short and long term numbness, can occur in the treated area. In addition, the treated area may appear red for a few hours after the applicator is removed.
• You may feel a dulling sensation in the treated area that can last for several weeks after your procedure.
• Other changes including deep itching, tingling, numbness, tenderness to the touch, pain in the treated area, strong cramping, muscle spasms, aching and or soreness also have been reported after a treatment.
• Patient experiences will differ. Some patients may experience a delayed onset of the previously mentioned occurrences. You should contact our office immediately if any unusual side effects offer or if symptoms worsen over time.
• In rare cases, patients have experienced vasovagal symptoms during treatment, and reported dead burn, darker skin color, hardness, discrete nodules or enlargement around the treated area. Surgical Intervention may be required to correct the enlargement. Treatment may cause new hernia formation or exacerbate pre existing hernia, which may require surgical repair. I understand that these and other unknown side effects may also occur.
• More than one treatment may be needed, depending on the side of the treatment are and the desired outcome.

 

I do not have any of the following medical issues and have not had any of the following medical conditions: Cryoglobulinemai or paroxysmal cold hemoglobinuria; known sensitivity to heat such as Raynaud's disease; Impaired peripheral circulation in the area to be treated; Neurophathic disorders such as post-herpetic neuralgia or diabetic neuropathy; Impaired skin sensations; Open or infected wounds; Bleeding disorders, Blood clot or concomitant use of blood thinners; Recent surgery or sir tissue in the area to be treated; A hernia or history of hernia in the area to be treated or adjacent to treatment site; Skin conditions such as eczema, dermatitis, or rashes; Pregnancy or lactation, and Any active implanted devices such as pacemakers and defibrillators.

 

 

By signing below, I understand and agree to the risks of this treatment.

I understand that the Body Contouring I receive is provided for the basic purpose of improving the flow of my lymphatic system and also for relaxation. If I experience any pain or discomfort during this session, I will immediately inform the practitioner so that the pressure and/or strokes may be adjusted to my level of comfort. I further understand that massage or bodywork should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor, or other qualified medical specialist for any mental or physical ailment of which I am aware. I understand that massage/bodywork practitioners are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such.

Because massage/ bodywork should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the practitioner updated as to any changes in my medical profile and understand that there shall be no liability on the practitioner’s part should I fail to do so.

*Please Note: Body contouring is a very powerful modality and certain medical conditions are contraindicated and determine if and when you can receive a session.

After the consultation and review of the information you have provided on this form, it will be determined if body treatments should be administered to you today. Some conditions will require a note from your doctor before proceeding. Please understand this is for your safety and well-being.

Procedure - It is recommended that a patient will need a minimum of six treatments for the low-level laser to achieve its potential effect. This treatment should be used in conjunction with a fat melting diet and exercise. If you are not currently exercising you should consult with the doctor before beginning an exercise program to determine if your body is the physically able. 

Risks/Discomfort - There are a few risks associated with low-level laser therapy. This treatment is non-invasive. During treatment, no discomfort will be present, the patient will not feel the laser, and however the light may or may not be visible. 

* Please inform us if you are pregnant, or are unsure if you may be pregnant, as a pregnancy test may be required to proceed with treatment. 

Diarrhea: when fat is successfully broken down, it must exit the body ass tool. You mayor may not notice an increase in bowel movements. Typically, diarrhea is mild and lasts no longer than 36 hours.

Increased urination: loss of water from your tissues is normal following the procedure and is a good sign that you are removing fat from your body. Fat enters the blood from the lymphatic system, increasing the “thickness” of the blood (oncotic pressure), and pulling water from tissues to carry the fat to the bowel for removal.

Flu-like symptoms: this is rare but can occur due to toxins in the fat being removed via the lymphatic system, causing congestion. Congested lymph pathways can lead to aches, pains, water retention, soreness, and flu-like symptoms.

Increased Hunger: this is the body’s attempt at returning to normal by re-accumulating fat. Do not increase food consumption! Follow a low carb, high protein, high fiber diet to combat hunger pains

Although no detrimental risks exist, potential unknown risks may exist. If you have a pacemaker, this treatmentmay not be right for you. It is recommended that one does not treat directly over a pacemaker or its lead wires.Please inform us of any metal that you have in your body. No known risks exist, however potential unknown risksmay exist. There is also a variety of other conditions for this treatment. It is possible that you may not see anyimprovement in your body shape or it may get worse. There also may be unknown risks associated with low-level laser therapy.

Alternatives: This is strictly voluntary cosmetic procedure. No treatment is necessary or required. Alternativetreatments, which vary in sensitivity, effect, duration, and invasiveness include: liposuction, mesotherapy,ultrasonic cavitation, laser lipo, lipodissolve, velasmooth, dieting, exercise, and potential others; which may have their own risks and benefits. 

Expectations: 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 Body Contouring. In order for you to reachthese goals, we have provided a few points to educate you on achieving your best results. It is important tomanage your expectations according to an appropriate diet, lifestyle and exercise program incorporated inconjunction with your Body Contouring treatment protocol. 

For best results:

- Drink plenty of water before and after treatment(s)

- Don’t eat 1 to 2 hours prior or following treatment(s)

- Perform physical activity following each treatment to maximize your results

- Manage caloric intake; excess calories will counteract the laser treatment

- Alcoholic beverages and high sugar content drinks must be avoided before and after treatment(s)

- Results vary based on individual body types.

You will not experience any discomfort from the gels used during your treatments

Rarely clients experience any discomfort during a session but in some cases a little warming may appear this will end when the treatment ends however if it’s too hot please advise your technician to lower temp.

Generally, clients can expect to see .05 inches to as much as 2.0 inches during treatment term If the client consumes the recommended water consumption it increases the results of the treatment.

PAYMENT: Payment in full is to be made prior to the start of any program or appointment.

NO REFUNDS IN THE EVENT CLIENT TERMINATES AGREEMENT: To encourage commitment and follow-through, the service provider offers no refunds. No refunds will be made on body contour treatments. There will be no exceptions. The prepaid program cannot be altered, shared or transferred, nor can it be combined with any other program. 

A 24-hour cancellation notice is required otherwise the non-refundable deposit placed during booking will be lost. All costs are payable in full prior to initial treatment and are Non-Refundable.

NO GUARANTEE OF RESULTS : Client recognizes that neither Office personnel nor this Agreement provides a guarantee of results. The Office makes no guarantee of the extent or longevity of improvement to be expected. This Agreement deals solely with the services to be rendered and the fees to be paid for the care as provided. The Client's payment obligation is not contingent upon the outcome of services. Client's results can be hindered and/or suppressed by the consumption of the following, but are not limited to, alcohol, processed foods including, but not limited to, sugar-based foods and drinks, etc. It is recommended to consult your physician for dietary modification clearance if you have any questions or concerns. To achieve optimum results, I understand that an appropriate diet and regular exercise will assist to sustain and create accumulative degree of overall spot fat reduction and body contouring.

RELEASE OF LIABILITY: Client agrees to indefinately, hold harmless and release the service provider, its agents, employees, officers, directors, representatives, assigns, members, affiliated organizations, and insurers, and others acting on the Company's behalf, of all claims, demands, causes of action, and legal liability, whether the same be known or unknown, anticipated or unanticipated, and further agrees that except in the events of the Company's gross negligence or willful and wanton misconduct, no claims, demands, legal actions and causes of action, shall be made against the Company for any economic and non-economic losses of any kind.

COMPLETE AGREEMENT

This Agreement constitutes the complete agreement and understanding between Clientand Office and will not be changed or modified in any way unless agreed to from both parties in writing. (Initials)

GOVERNING LAW

This Agreement shall be governed, construed and interpreted, through and under the Laws of the State of Georgia.

THE CLIENT HAS FULLY READ THIS AGREEMENT AND UNDERSTANDS AND AGREES TO ABIDE BY ALL OF THE TERMS HEREOF.

I certify that I have been fully informed of the nature and purpose of the procedure, expected outcomes andpossible complications. I understand that no guarantee can be given as to the final result obtained. I am fullyaware that my condition is of a cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so. I understand that it is my personal responsibility to inform the clinician of any changes to my medical history during the course of the treatment sessions and I confirm that should this occur I shall advise the clinician of any changes. 

 

I certify that I have been given the opportunity to ask questions and that I have read and fully understand the contents of this consent form.

 

Please read carefully and understand the contents of this form. Ask us if you not understand. When a client seeks Body Contouring services and when the service provider accepts a client, it is essential that both are seeking and working for the same goals. We expect our clients to take full responsibility for their decisions to participate in any of the services/programs offered by this office. We do not identify, diagnose, or treat ANY condition or disease. We have only one goal: TO OPTIMIZE YOUR BODY'S ABILITY TO FUNCTION NORMALLY AND OPTIMIZE YOUR FAT-BURNING POTENTIAL. By reducing biostress levels, we allow the body's inborn self-correcting mechanism to work at maximum efficiency to restore, maintain and promote wellness.

We do not identify or diagnose any condition(s) or disease(s). We offer no treatment for any condition(s) or disease(s). We promise no cure from any disease(s) or condition(s). Instead, we facilitate your body's own self-correcting mechanism.

It is essential that you speak to your doctor prior to making any decisions about altering any medical regimen you are currently following, changing your diet, taking supplements, or going on an exercise and/or weight loss program. Getting your doctor's approval prior to starting any service/program at our office is critical and solely your responsibility. Should any health condition arise while you are a client, we recommend that you immediately see the appropriate health care provider.

Any options that are rendered by the staff and/or head personnel should NEVER be construed as medical advice but merely as opinions. If you like medical advice, please see one of our medical doctors. We will not deal with any medical condition.

With your signature below, you understand and accept the risks and agree that neither the provider, its staff, will be liable for any injury to you, including, but not limited to, personal bodily injury, death, mental injury, economic loss or any damage to you, your spouse, or relatives resulting from any act of the service provider, and its staff or anyone else using the facilities and that you acknowledge the inherent risks of the positions, movement, dietary/nutritional programs offered to and done to you at the service provider, with respect to your current or past condition(s). If there is any dispute between you and the service provider, and/or any of its staff, both parties agree to submit it to binding arbitration. We both agree to have a neutral arbitrator preside over any such dispute, not a judge or jury.

I, the undersigned, understand and accept the conditions as laid out in the “Terms of Acceptance” above.