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Consent Form for Treatment
I consent and authorise the practitioner to carry out cryolipolysis treatment as discussed and agreed. I declare that I have been informed of the cost and procedure of treatments. I have been informed of any secondary and undesired effects, as such I hereby discharge the practitioner from all claims, demands, actions and causes of action arising out of the performance of the said treatment.
Cryolipolysis is a treatment designed to help reduce fat from stubborn areas of the body. It is not a weight loss system and its purpose is to improve shape and tone.The non invasive method used works by the process of cooling the subcutaneous fat cells. Results can take up to 6 weeks to see the full benefits. On average clients see a reduction of 1 to 2cm from arms/legs and 3 to 5cm from abdomen.
- The treatment area should be clean and free of any moisturisers/tanning products
- The treatment time varies depending on the areas to be treated on average is approximately 30 minutes
- The practitioner should be informed of any recent illness or skin condition, latent or active
- Treatment will not be carried out if the skin is wounded or there is an active infected area which is due to be treated
- We would advise wearing loose clothing over the treatment area after the treatment is completed.
Secondary and Undesired Effects
Sensitivity and stiffness: Skin sensitivity and stiffness can occur and can typically take a couple of days to recover. There may also be a temporary colouration of the skin which can take a few days to go back to normal.
Nausea/dizziness: You may feel slightly dizzy or nauseous straight after your treatment as your body naturally tries to warm up, this will subside within a couple of hours.
You may notice that as your lymphatic system is processing more waste than normal you may urinate from frequently than normal and have slightly looser bowel movements.
As with any procedure the risks are not limited to the above and some side effects may not yet be studied and recorded. Cryolipolysis may not be recommended if any of the conditions in the medical questionnaire are present.
The probability of success: Multiple treatments may sometimes be needed, results are accumulative, and vary from one client to the other. Follow up treatments may be required in the future. For reasons that are unknown there is a small percentage of clients that may not achieve a satisfactory difference, as such results are not guaranteed.
I agree to adhere to all safety precautions and regulations during the Cryolipolysis, Brazilian Bum Lift or non Surgical Breast Lift treatment. I accept that the treatment is carried out in good faith and accept that this risk is taken by me. I understand that refunds for treatments will not be given unless written confirmation that treatment should not go ahead is provided by a medical practitioner.
Tap or click on the signature above to sign
Tap or click on the signature above to sign
Data Protection and Privacy
We are committed to protecting your privacy. We take special precautions with your sensitive personal data and we will process your data lawfully and as described. We only process the data we need for as long as we need to and we respect all of your rights under GDPR. We will never sell, share or otherwise abuse your data. You can contact us at anytime to request your data, change your preferences or request that your data be deleted. GDPR is the European privacy law designed to protect you and give you control of your data.
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Appointment Guidance
- Please only attend at your appointment time
- Please ensure you are on time - if you are late this may result in your appointment being cancelled
- Please attend your appointment unaccompanied
- Please limit the personal possessions you bring with you
- Hand sanitiser will be provided upon arrival and will be available throughout your appointment
- Please wear a face covering to enter and walk around the salon/clinic
- We encourage contactless/card payments where possible
- If you experience Covid-19 symptoms after your appointment please contact us immediately
Please DO NOT attend your appointment. Please contact us to cancel / reschedule.
Please DO NOT attend your appointment. Please contact us to cancel / reschedule.