Patient Agreement

Body Sculpting

 I understand that I am beginning a series of treatments to help reach my goals of body contouring and spot fat reduction. I understand that individual results may vary and that I must commit to changing the dietary and lifestyle factors necessary to achieve optimal results. 

 

I understand that the first step to a positive change is creating awareness about the steps necessary to reach these goals, and will work diligently to ensure success. I understand that much of the success of the program will depend on my efforts and that there are no guarantees or assurances that the program will be successful. I realize there may be pre-existing medical conditions that can preclude me from seeing optimal results. By signing this agreement I release the spa/clinic, manufacturer and distributors from any liability regarding this treatment and do so understanding that results can vary from one individual to the next.

 

I understand there are no guarantees as to the results of this treatment 

I understand that to achieve maximum results, I may require several treatments 

To achieve optimum results, I understand that an appropriate diet and regular exercise will assist to sustain and create an accumulative degree of overall spot fat reduction and body contouring 

 I have read and fully understand this consent form and I realize I should not sign this form if all items have not been explained to me. My questions have been answered to my complete satisfaction. I have been urged and have been given all the time I need to read and understand this form.

 If you have any questions regarding the risks or hazards of the proposed treatment or any questions what so ever concerning the proposed treatment or other possible treatments, ask your doctor now before signing this consent form. 

 

Risk:

 

I have been informed and I understand the temporary hyperpigmentation/hypopigmentation on rare occasion may occur as a result of treatment. I hereby certify that all the information that I have provided has been accurate and truthful. I hereby authorize Diam Diva Spa to perform the procedure for the purpose of aesthetic body contouring                  


           

857.770.1084

82 Walnut St Dedham, MA 02026

Lower Level

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