Client Intake Form

Client Intake Form2018-02-20T15:59:56+00:00
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Medical History


Photography


Acknowledgement


Confirmation

Lipo Laser is one of the tools that we can use to help you reach your goals and the real advantage of this technology lies in the fact that we can specifically target a trouble area. Once the fats have been released from the cell they can be used by the body as a fuel source. Dietary and lifestyle changes are encouraged to help support the goals of treatment.

Ensure Your Best Results

For optimal results drink lots of water before and after treatments to help liquefy the fat. The fat cells are filled with triglycerides and this is helpful in making the content thinner so it is easier to excrete. Nothing by mouth except water 2 hours before. You can eat immediately after the treatment. Remember that after the treatment the pores are open. Do not consume anything high in carbs, sugar or fat for 24 hours. Avoid alcohol for 24 hours because your body wants to process sugar from alcohol before the glycerol from the fat cell. Do 10 minutes on the whole body vibration plate in order to accelerate the removal of the released fat by helping with lymphatic drainage. Some people will do 20 to 30 minutes of cardio on their own in addition and they always report that they lost even more inches in the 24hr period. Not everyone follows these guidelines and we understand if you don’t. You will still get results. BUT, for optimal results if you follow the above recommendations you will see considerable progress in your laser lipo journey.

What to Wear

We recommend that women wear a sports bra and yoga pants. Men should wear briefs that are a little more form fitting.

Risks:

I have been informed and I understand that temporary hyperpigmentation / hypopigmentation on rare occasion may occur as a result of treatment.

Consent for Treatment and Release of Liability

By signing this agreement I understand that I am beginning a series of laser lipo treatments to help reach my goals of body contouring and spot fat reduction. I understand that individual results may vary and that I must commit to changing the dietary and lifestyle factors necessary to achieve optimal results. I understand 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. Because laser lips treatments should not be performed under certain medical conditions, I affirm that I have stated all of my known medical conditions, and answered all questions honestly. I agree to keep the practitioner updated as to any changes in my medical profile. By signing this agreement, I release the spa/clinic, manufacturer and licensee end-user from any and all 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. My questions have been answered to my complete satisfaction. My signature herein constitutes my acknowledgment that I am a competent, consenting adult of at least 18 years of age (or my parent or legal guardian is giving consent on my behalf ).
   
       
                       
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