Harmony Sculpt

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Consent Form

Customer Information

Name
Must be 18 years old.

Emergency Contact Information

Name

Health Issues

Do you have any of the following issues?
Do you have photosensitivity to sun exposure or are you taking any drugs that cause photosensitivity?
Do you have any of these skin conditions?
Do you have a metal or copper IUD?
If yes, doctor's note may be required
Are you on your menstrual period?

Acknowledgments

Terms and Conditions
- I understand that this procedure cannot guarantee 100% expected results and that several treatments might be needed to achieve good results.

- I allow Harmony Sculpt to take photographs, videos, and measurements of my before and after results as proof of the treatment and give permission to use these materials for advertising, marketing, or educational purposes.

- I confirm that all information provided in this form is accurate and true to the best of my knowledge.

- To achieve optimum results, I understand that maintaining a healthy diet, lifestyle, and regular exercise will support the outcomes I am seeking.
Service Policies
- A minimum of 24 hours’ notice is required for any appointment changes or cancellations

- A 15-minute grace period is allowed for unexpected delays; arrivals beyond this time will need to be rescheduled

- Missed appointments (no-shows) must be paid in full before rebooking

- In the event of a no-show, $40 of the service cost (the deposit amount) will be retained
Clear Signature
By signing this agreement, I acknowledge and accept that results from the treatment(s) provided by Harmony Sculpt may vary from one individual to another. I release Harmony Sculpt from all liability related to these treatments. I understand that achieving my personal body goals through body contouring requires commitment to positive lifestyle changes. To ensure the success and longevity of my results, I agree to adopt and maintain healthy habits, working in harmony with the treatment(s) provided.

Preparing for Your Treatment

To support the best possible results, we recommend the following:
1. Stay well-hydrated before and after your session
2. Please refrain from eating for at least 2 hours prior to your appointment
3. Light physical activity (such as walking or exercise) is encouraged
4. Be mindful of food choices around your treatment time
5. Avoid alcohol and high-sugar beverages before and after your session

Ready to sculpt your dream body?

Let’s create a plan that’s tailored to YOU! Book your treatment plan today!

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