DISCLAIMER
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Disclosure - This treatment is a process and subsequent visits my be necessary in order to achieve the desired results. Subsequent visits are subject to additional charges per visit depending on the amount of work needed.
Actual results vary from person to person and SOLÉI Body Contouring Spa does not guarantee any specific results. The Ultrasonic treatment carries with it possible health complications and consequences, which include but might not be limited to the risk of kidney failure, liver failure, pacemaker failure, birth defects, miscarriage, thyroid damage, damage to the ovaries, lactation complications, elevated triglycerides, elevated cholesterol, pancreatitis, infection, scarring and/or allergic reaction to any products used, excessive thirst, dehydration, nausea.
The Ultrasonic treatment includes, but is not limited to, the use of high-power low-frequency ultrasound cavitation, which uses 40KHz frequency ultrasound to penetrate the skin and assist with the breakdown of fat cells by creating micro-bubbles that increase the pressure around the adipocyte and force it to implode, thus breaking down adipocyte’s cell membrane.
After Care - After care instructions must be followed explicitly, whether given in writing or orally. Failure to follow after care instructions my compromise the final results of the treatment.
Release - I recognize that there are certain inherent risks associated with the above described treatment and I assume full responsibility for personal injury to myself. In exchange for such treatment, I hereby fully release and forever discharge SOLÉI Body Contouring Spa (including is officers, members, owners, employees and agents) from any and all damages, costs, expenses, liabilities, causes of action, claims and demands, of whatever character, in law or in equity, whether known of unknown, direct or indirect, asserted or un-asserted, and whether or not on account of myself, SOLÉI Body Contouring Spa or other third parties, or in any way arising out of the above described treatment I have requested SOLÉI Body Contouring Spa perform. It is the intention of the parties that this agreement binds all parties whose claim may arise out of or relate to treatment or services provided by SOLÉI Body Contouring Spa Including any spouse or heirs of the client/patient and any children, whether born or unborn. Any legal or equitable claim that may arise from participation in the treatment shall be resolved under Connecticut law.
I agree to indemnify, hold harmless and defend SOLÉI Body Contouring Spa (including its officers, members, owners, employees and agents) against all third-party claims, causes of action, damages, judgments, cost or expenses, including attorneys’ fees and other litigation costs, which may in any way arise from the above described treatment I have requested SOLÉI Body Contouring Spa perform.
By signing and submitting this agreement I confirm that I am over the age of 18, I understand that the Ultrasoonic procedure is permanent, that such a procedure has possible adverse consequences and that the procedure is for cosmetic purposes only.
I certify that I have read the above paragraphs; fully understand this consent and procedure form and hereby consent to the indicated procedure. This means I fully accept full responsibility for these and/or any other complications which may arise or result during or following the Body Sculpting procedure which is to be performed at my request according to this agreement. I further understand that by signing this agreement, I surrender certain legal rights.