Non surgical Consultation Form

Client Name(Required)
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Gender(Required)
Address(Required)
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Do you have any of the following?(Required)
How is your sleep pattern?(Required)
How is your diet?(Required)
Are you fully committed to making the relevant changes to get the best possible results from your treatment?(Required)
Informed client consent to body sculpting treatment: I consent to, and authorise, Skin & Mind Clinic qualified practitioners to carry out ultrasound cavitation/radio frequency treatments as discussed and agreed.(Required)
The treatment has been fully explained to me. I understand that this treatment will take several sessions and a course of treatments is recommended for best results. * I have been advised that results vary from person to person and that results will also depend on how well I follow my aftercare advice. * I agree to follow all the aftercare advice as provided by my therapist (namely, drinking lots of water, regular body brushing, following a healthy diet and partaking in regular exercise). Whilst I understand that the results from the treatments vary considerably, I accept that all treatments are to be carried out in good faith with the best possible achievable outcome observed. * I understand that there is a risk of some side effects including but not limited to reddening, bruising, tenderness and in rare circumstances there is a small risk of a burn that may or may not lead to scarring. I accept these risks are possible and do not hold the therapist or Skin & Mind Clinic responsible for any adverse reactions that may occur from treatment. * I have asked all relevant questions appertaining to this treatment and am satisfied with the explanation and information given to me regarding the possible side effects and outcome of Ultrasound Cavitation and/or Radio Frequency.(Required)
I have been given full pre and post treatment advice and understand and agree to follow these guidelines at all times during the treatment programme.(Required)
In the unlikely event of an adverse reaction, I will advise Skin & Mind Clinic within 24 hours and, in the case of more serious side effects, will contact my GP to obtain medical advice. I confirm that I am over the age of 18 years • I confirm that I have read and agree to all the guidelines and recommendations of this Informed Consent Form.(Required)
I agree to the Terms and Conditions for Body Contouring Services set out below(Required)
Terms and Conditions for Body Contouring Services: 1. Missed Appointments: If you miss an appointment, it will be deducted from your scheduled sessions. We require a minimum of 48 hours' notice to reschedule an appointment, or you will lose that session. 2. Payment Plans: All payment plans are non-cancellable. If you breach the payment plan agreement, you will be billed for the remaining cost of the services. 3. Consultation and Contract: The consultation form will serve as our binding contract, indicating that you are happy to proceed with the body contouring services. 4. Trust and Breach of Agreement: We are placing our trust in you with the payment plans. Please note that any breach of the agreement will result in us contacting our solicitors. Remember, your body contouring journey is a commitment to yourself. We're here to support you every step of the way, and we're excited to see the amazing results you'll achieve!
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