Emsculpt Consent form

This page explains our terms of service FOR THE emsculpt TREATMENT, which contain important information.

When you book an emsculpt appointment or PACKAGE with the Beautyholic bar, you’re agreeing to these terms AND ARE AWARE OF ANY RISKS.

YOU NEED ONLY FILL/SIGN THIS FORM ONCE.

The purpose of this informed consent form is to provide written information regarding the risks, benefits and alternatives of the procedure named above. This material serves as a supplement to the discussion you have with your service provider. It is important that you fully understand this information, so please read this document thoroughly.

If you have any questions regarding the procedure, ask your service provider professional prior to signing the consent form or email us: inquiries@thebeautyholicbar.com

What is the treatment?

You are scheduled for a series of non-invasive treatments using emsculpt neo. The device is indicated for non-invasive lipolysis (breakdown of fat) of the abdomen and for reduction in circumference of the abdomen in Skin Types I to III. The device is also cleared for improvement of abdominal tone, strengthening of the abdominal muscles, development of firmer abdomen, Strengthening, toning and firming of buttocks, thighs and calves. Improvement of muscle tone and firmness, for strengthening muscles in arms.

Your treatment provider will discuss your specific treatment needs. The recommended number of treatments is 4. The treatment is typically about 20-30 minutes per session, with sessions separated by 5 to 10 days.

Completing a full treatment series is necessary to maximize treatment efficacy. You may need additional treatments, depending on your goals.

Before the treatment:

you are not required to do anything special, however, keeping your body well hydrated is strongly recommended. On the day of the treatment, you are advised to wear comfortable clothing, allowing flexibility for correct positioning during the treatment. You will be asked to remove all metallic accessories and electronic devices. I acknowledge that a successful treatment outcome can be affected by smoking or excessive alcohol consumption and eating disorders or on-going medication. While no special diet is required, you are encouraged to eat healthy to help promote and maintain results. The treatment does not require anesthesia. During the application, you will feel intense muscle contractions and heating sensation in the treated area. The procedure doesn't require any recovery time. Typically, you can get back to your daily routine right after the treatment.

I am aware NOT TO wear any metallic accessories (such as jewelry, watch or clothes containing metallic threads or metallic accessories) during the treatment. I also acknowledge that I do not have any metallic or electronic implants (such as pacemakers, defibrillators, metallic IUDs, etc.)

Treatment considerations

  • I am aware that the treatment cannot be applied over the head, heart and neck

  • I am aware that pregnancy is contraindicated, and pregnant women cannot undergo the treatment.

  • I am aware that as is the case with every heat-based therapy, in rare cases, an occurrence of localized overheating of tissue cannot be excluded

  • I am aware that the applicators must be in full contact with the bare skin

  • I am aware that no therapy can't be performed through clothing

  • I understand that there are certain risks associated with Emsculpt neo treatments and they include but are not limited to muscular pain, intramuscular fat decrease, temporary muscle spasm, temporary joint or tendon pain, local erythema or skin redness, increased menstrual flow in female patients and panniculitis.

  • I understand that the treatment over injured or otherwise impaired muscles is contraindicated

  • I understand that the treatment may involve risks of complications or injury from both known and unknown causes, and I freely assume these risks

  • I agree to before and after treatment photographs, measurements and weighing, as this will help for medical evaluation of the results of the treatment. Information will be acquired for medical records or marketing purposes

  • I understand the results may vary from person to person and that an exact result cannot be predicted. Completing a full treatment series is necessary to maximize treatment efficacy. It is very unlikely, but it is possible that you will not feel any recognizable result after the procedure. I acknowledge the results may not meet my expectations.

I certify that I have read this entire document and that I agree with all provisions.

I certify that I have had the opportunity to ask questions and these questions have been answered in full to my satisfaction. I fully understand the treatment conditions, the procedure, and possible side effects.

I have read the above information, and I request and give my consent to be treated with the EMSCULPT NEO by the physician(s) in this practice and his/her designated staff

My signature below indicates that the above information is accurate and current.

I understand this is an elective procedure and I hereby voluntarily consent to the emsculpt treatment. The procedure has been fully explained to me. I also understand that any treatment performed is between me and the Service Provider who is treating me and I will direct all post-procedure questions or concerns to the treating Service Provider. I have read the above and understand it. My questions have been answered satisfactorily. I accept the risks and complications of the procedure and I understand that no guarantees are implied as to the outcome of the procedure. I also certify that if I have any changes in my medical history I will notify the Service Provider who treated me immediately.

I have read and understand the post-treatment home care instructions. I understand how important it is to follow all instructions given to me for post-treatment care. In the event that I may have additional questions or concerns regarding treatment or suggested home product/post-treatment care, I will consult the Specialist immediately.

I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies, prescription drugs or products I am currently ingesting or using topically. I have read and fully understand this agreement and all information detailed above and I consent to the terms of this agreement. I do not hold Specialist, sonia Felix, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today. I also release any liability that may arise from this procedure.

I also state that I read and write in English.