Consent for Treatment
I duly authorize the technicians of Lipo-Light to perform the procedure for the purpose of body contouring, lymphatic drainage, improving the appearance of cellulite and skin tightening. I am aware that clinical results may vary depending on individual factors, including medical history, patient compliance with pre/post treatment instructions, and individual response to treatment. I have been made aware that my diet and the amount of exercise I do will have a major effect on the results of my treatments.
If I do not make an effort to address my diet and exercise I am aware that the results achieved may not be retained. I understand that treatment by Lipo-Light involves a course of treatments. The fee structure has been fully explained and
I understand that I am required to pay for a course of treatments prior to any procedures taking place. I am fully aware that should I wish to cancel the course, the value of the outstanding treatment is non refundable. Due to demand for treatments we schedule all appointments following the initial consultation. Please be aware that all cancellations require a minimum of 24 hours notice. Failure to do so will result in that treatment being deducted from your course without a refund. It is important to be aware that this may have a negative effect on your overall results. Any changes to the initial treatment dates will be subject to availability. If you are more than 10 minutes late we may not be able to accommodate your treatment appointment, as this may inconvenience other clients. PWLC reserves the right to deduct a treatment from your treatment course without a refund.
I certify that I have been fully informed of the nature and purpose of the Lipo-Light procedure, expected outcomes and possible complications, and I understand that no guarantee can be given as to the final result obtained. I am fully aware that my condition is of a cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so. I am aware that the Lipo Light may cause slight hypo/hyper-pigmentation of the skin and treatment is taken at my own risk (tattoo areas should be avoided).
I agree that I have read the Lipo Light Therapy Service FAQ's on the touchandglowstudio.com website
I understand that it is my personal responsibility to inform the therapist of any changes to my medical history during the course of treatment sessions and I confirm that should this occur I shall advise the therapist of any changes. I consent to the taking of photographs and authorise their anonymous use for the purposes of medical audit, education and promotion. I certify that I have been given the opportunity to ask questions and that I have read and fully understand the contents of this consent form.
By submitting this form you consent to treatment and the above consent form.