Liposincirugia

Please enable JavaScript in your browser to complete this form.

Client Consent Form and Disclaimer
I hereby consent to and authorize LIPO SIN CIRUGÍA to perform the following procedure:

Procedure

I have voluntarily elected to undergo this treatment/procedure after the nature and purpose of this treatment has been explained to me, along with the risks and hazards involved. I have been informed of possible benefits, risks, and complications. I also recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require further treatments of the treated area to obtain the expected results as an additional cost. I have read and understood the post-treatment care instructions. I understand that it is my responsibility to follow all instructions given to me regarding my treatment or suggested home-care treatment. In the event that I have any concerns regarding my treatment or subsequent treatments, I must contact the salon as soon as possible to obtain further instructions for my care. I also, by the below signature, acknowledge that I have disclosed, to the best of my knowledge, an accurate account of my medical history and any current medications I am using, including any prescribed drugs or problems. I understand that I have the responsibility to disclose any medical conditions that could affect the outcome of the treatment. I understand all questions have been answered to my satisfaction and that I accept the risks.I do not hold the esthetician responsible for any conditions I may have that were not disclosed at the time of this skin care procedure, which may affect the treatment performed today. I verify that I have read and understood this consent form and hereby authorize the treatment, personal data collection and use, including images of my face/body, and use my phone number for marketing purposes.

Clear Signature
Clear Signature