Body Sculpting I N T A K E F O R M Name * First Name Last Name Have you received any body sculpting before? * Yes No Please mark any of the following conditions you may currently have Contagious skin disorders Coldsores Cancer, chemo or radiation Cardiac Disease Pacemaker or internal defibrillator Laser or ipl within last 7 days Epilepsy Kidney disease Liver disease or high cholesterol? Pregnant or breastfeeding I understand that with body sculpting we use heat and ultrasound technology.I understand that theBody Sculpting technician does not diagnose any illness, disease or any other physical * I understand I understand that even though I may see results today, this cannot be guaranteed as everyone's body is completely different I understand Thank you!
