Please read this consent form entirely.
Ultrasound, Fat Cavitation, RF & Vacuum Cellulite New Client Intake Form
I have been advised and fully informed of the ultrasonic cavitation treatment and its uses ultrasound frequency to penetrate the skin and assist your body in breaking down fat cells. Multiple sessions may be required to achieve desired results at an additional cost. Ultrasound Cavitation carries possible health risks and complications including but not limited to kidney failure, liver failure, pacemaker failure, birth defects, miscarriage, thyroid damage, ovary damage, hyper-tryglyceridemia, hyper-cholesterolemia, pancreatitis, infections, scarring, and/or allergic reactions to any products used during the treatment(s).
I have been advised and fully informed of the vacuum suction procedure is a mechanical lymphatic drainage treatment. It stimulates the lymphatic system and aids the removal of waste products draining lymph from the tissues, improving the colour and appearance of the skin. Used in conjunction with Ultrasound Body Contouring, it encourages the released fat to be taken on by the lymph system, exiting the body through natural sweat, urine and bowel movements. The nature of the process proposed, along with all risks, reponses and pre and post care instructions. I hereby authorize and direct them to perform such process and perform such services as may be deemed necessary or advisable. I understand that manual lymphatic drainage should not be considered a substitute for medical examination, diagnosis, or treatment, and I should see a physician, or other qualified medical specialist for any mental or physical ailment of which I am aware. I have been advised and fully informed of Radio Frequency treatment.. I understand the contraindications and possible side effects of the Radio
Frequency procedure as discussed with “Monroe Sunshine Coast”. Furthermore, I agree to waive all liabilities toward “Monroe Sunshine Coast” for any injury or damages incurred due to my misrepresentation of my health history.
By submitting this form I have read and accepted the terms and conditions and understand that all current and future treatments with Monroe Sunshine Coast and all associated risks and possible side affects from Fat Cavitation, radiofrequency & Cellulite Vacuum treatments at “Monroe Sunshine Coast”.
I agree that the information I have provided is true and correct.