$20,494 to $197
Contour Collective Form 3 of 3
CONSENT TO RECEIVE SERVICES
You may receive multiple types of treatments in the course of receiving body contouring services. Please review and provide consent for each.
EM BODY SCULPT+ (EMS)
EM Body Sculpt+ (EMS) uses High Frequency electro-magnetic technology to stimulate the skeletal muscle and muscle fibers to ‘work out’ the muscles. It creates alternating quick and rapid contractions, long contractions and contractions with pauses.
The technology may feel like a hard ‘workout’ (both during and after treatment), but should not be painful. At 24 hours post treatment, you may feel sore like after an intense workout. At 48 hours, you feel more sore than at 24 hours. After that, your soreness should start decreasing.
EMS technology is safe for most people but there are some medical contraindications such as implanted devices and seizure disorder. Please let us know if you have any implanted devices (such as pacemakers, drug pumps) or if you have been diagnosed with a seizure disorder.
Low-Level Light Therapy
Low-Level Light Therapy uses LED Technology is a non-ablative procedure utilizing light emitting diode technology to treat a multitude of concerns including cellulite, poor lymphatic drainage, unwanted fat, loose skin, scarring, and stretch marks. It’s a natural treatment (photobiomodulation) much like the process of photosynthesis, using green and red wavelengths to stimulate your body’s own regenerative metabolism at the cellular level or to damage fat cells and cause their lipid contents to be released.
The technology is non-invasive and should feel good - not produce pain or discomfort; however, if you experience any uncomfortable effect, please report adverse reactions immediately.
LED technology is safe for most people, but certain contraindications do exist. PLEASE ADVISE US if you are pregnant or lactating, have been diagnosed with a seizure disorder or if you are taking any medication that causes photosensitivity, such as Accutane.
Ultrasound Fat Cavitation Consent
Ultrasound Fat Cavitation delivers highly focused sound waves to damage fat cells. The energy from the sound waves creates swift pressure changes within the body’s tissues that causes fat cells to break down, rupture, and release the lipid contents into the surrounding tissues. The body then picks up, metabolizes and eliminates the lipids. Vacuum technology and Vibration Therapy are technologies that are often used following cavitation to assist in the body’s lymphatic system to eliminate the lipids from the body. Lymphatic massage can also assist the body in eliminating the lipids and other debris.
Cavitation technology is safe for most people but certain contraindications do exist. PLEASE ADVISE US if you are pregnant or lactating, have an implanted device such as a pacemaker, defibrillator, insulin pump or any other implanted device, or have been diagnosed with a seizure disorder.
Cavitation technology is non-invasive; however, you may experience tinnitus (ringing in the ears) during treatment caused by the sound waves as they move through your body, redness, and bruising
Radiofrequency (RF) Technology
RF (Radiofrequency) energy produces a controlled heating that penetrates your skin and naturally stimulates the production of collagen, referred to as collagen remodeling. This results in your skin becoming more elastic, firm, tight and smooth over time. RF energy can also damage fat cells and assist in fat reduction.
RF technology is safe for most people but certain contraindications do exist. PLEASE ADVISE US if you are pregnant or lactating or have implanted devices such as a pacemaker, defibrillator, insulin pump, or other device, or if you are taking medications causing photosensitivity, like Accutane.
RF technology is non-invasive, produces heat, but should not cause pain; however, please report any discomfort to your treatment specialist. Your treatment specialist has the ability to turn down the energy to bring your treatment to a point where it is comfortable for you.
Though your treatment specialist will be monitoring closely, there is a possibility of burning. To avoid a burn, it is crucial to tell your treatment specialist if it becomes hot or becomes painful. You may have a sunkissed feeling after your treatment, mild swelling, and/or experience redness to the area that goes away in 2 -24 hours.
Consent & Release
I acknowledge that body contouring treatments, including, but not limited to: low-level light, radio frequency, electromagnetic muscle stimulation, cavitation, vibration, and various other beauty procedures is not an exact science and no specific guarantees can or have been made concerning the outcome. I understand that some clients experience more change and improvement than others. In virtually all cases, multiple treatments are required in order to realize a difference.
On behalf of myself, my heirs, my executors, and my administrators, I understand and agree to assume the following risks and hazards which may occur in connection with any particular treatment including but not limited to: unsatisfactory results, soreness, poor healing, discomfort, redness, blistering, skin damage, nerve damage, disability, death, scarring, infection, change in skin pigmentation, allergic reaction, eye damage, change or damage to my vision, muscle damage, and increased hair growth. I understand that even though precautions may be taken in my treatment, not all risks can be known in advance.
Given the above, I understand that response to treatment varies on an individual basis and that specific results are not guaranteed. Therefore, in consideration for any treatment received, I agree to unconditionally defend, indemnify, hold harmless and release from any and all liability, costs of litigation and any other costs of every kind and nature, the company and the individual that provided my treatment, the insured, their insurance company, and any additional insureds, as well as any officers, directors, or employees of the above companies for any injury, property damage, condition or result, known or unknown, that may arise as a consequence of any treatment that I receive.
In the event any provision of this agreement is found to be legally invalid or unenforceable for any reason, all remaining provisions will remain in full force and effect. In the event any provision of this document is found by a court of competent jurisdiction to exceed the limits permitted by any applicable law or to be invalid or unenforceable as written, such court (s) may exercise its discretion in reforming such provision(s) to the extent necessary to make it reasonable and enforceable.
The undersigned waives, to the fullest extent permitted by law, any right they may have to a trial by jury in any legal proceeding directly or indirectly arising out of or relating to this agreement whether based in contract, tort, statute (including any federal or state statute, law, ordinance, or regulation), or any other legal theory.
The client indicated below understands that any claims are processed through the insurance company’s South Dakota office and agrees that this contract will be governed and construed in accordance with the laws of the state of South Dakota and that all actions of any kind whatsoever will be filed, heard, governed, arbitrated, and restricted to the venue of the County of Meade County, South Dakota. The undersigned also agrees and stipulates that they will be responsible for any legal, or other costs of any kind, incurred by the insured or their insurance company in defense of this agreement should the undersigned challenge its enforceability.
The client indicated below also agrees to forever hold harmless and release from any and all liability, claims, or demands of any kind or nature the insured, and their insurance company for the transmission of any disease, condition, injury or illness they may allege to have contracted or been exposed to as the result of any treatment, person, or visit at the insured's location or the location of treatment.
I have fully disclosed on my client intake form any medications, previous complications, or current conditions that may affect my treatment. In consideration for treatment received, I hereby grant permission to the individual or company that provided my treatment to use any photographic treatment records for the purposes of clinical and statistical studies, advertising, or promotion without any additional compensation to me.