Sample Page - Body Sculpt

This is an example page. It’s different from a blog post because it will stay in one place and will show up in your site navigation (in most themes). Most people start with an About page that introduces them to potential site visitors. It might say something like this:

Hi there! I’m a bike messenger by day, aspiring actor by night, and this is my website. I live in Los Angeles, have a great dog named Jack, and I like piña coladas. (And gettin’ caught in the rain.)

…or something like this:

The XYZ Doohickey Company was founded in 1971, and has been providing quality doohickeys to the public ever since. Located in Gotham City, XYZ employs over 2,000 people and does all kinds of awesome things for the Gotham community.

As a new WordPress user, you should go to your dashboard to delete this page and create new pages for your content. Have fun!

Body Sculpting Treatment Consent Form

I am not pregnant, trying to get pregnant or breastfeeding.

I do not have any medical devices implanted including but not limited to; a pacemaker, hearing aids, hormonal pellets, an IUD or any metal implants.

I do not have epilepsy.

I do not have uncontrolled hypertension or high blood pressure.

I do not have any known kidney or liver disorders.

I am not pregnant, trying to get pregnant or breastfeeding.

I do not have cancer or a history of cancer.

I do not have any known thyroid gland dysfunctions.

I do not have a compromised immune system.

I have no photo sensitivity to sun exposure.

I do not have a heart disease or other heart conditions.

I understand that there could be possible risks and side effects that could occur. These may include, but are not limited to, mild to extreme redness, bruising, swelling, puffiness, or irritations that may last on average between 7 to 10 days.

I understand during menstruation, I am unable to receive the treatment and will need to reschedule my appointment day.

I give consent to taking photographs during the progress of my body contouring treatment.

I understand the BODY SCULPT MB cancellation and no show policy. The full amount must be paid and loss of the session (if packaged was purchased).

I give consent to taking photographs during the progress of my body contouring treatment.

Acknowledgement:

I understand each person has a different response to the body contouring treatments. The risks, benefits and possible results have been explained to me and if I am unsure, I have confirmed with my doctor that I am able to continue with this procedure. I have been honest with BODY SCULPT MB in terms of my health and I am in good health to continue with treatment.
I understand that in order to maintain and ensure I receive the best results, that I must drink 1.5-2 litres of water before treatment, treatment day and the day after treatment and maintain at least 30 mins of any exercise daily. Also having a healthy, low in fat diet, at least during the following five days to obtain long lasting results. (Always under medical supervision).I have read through the descriptions of the treatments and understand the processes of it. I have been provided the opportunity to ask questions and received satisfactory responses.
I voluntarily provide my consent to partake in the body contouring procedure, should any pain or discomfort occur, I will immediately notify BODY SCULPT MB. I will not hold the service provider liable for any irritation or effects of having going through with the body contouring procedure. By signing, I consent and authorize BODY SCULPT MB to perform body contouring treatments, which may include ultrasound cavitation, radio frequency, vacuum therapy, and laser lipo.
This consent form is good for six months after signing, if you continue to come back to BODY SCULPT MB for any body contouring services after the six months, you must resign this consent form.

First Name

Middle Name

Last Name

Date of Birth

Instagram Account

# of Sessions

Main Areas of treatment

How did you hear about us?

Any Issue

Clint Signature

Address

Address Line 1:

Address Line 2:

Country:

City

State/Province

Zip/Postal:

Email Address

Confirm mail

Check to receive information, news, and discounts by e-mail.

Emergancy Contact

Emergency Contact's Name

Emergency Contact's Email

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.