Patient Consent and Information for Body Contouring

Face

Facial Rejuvenation and Contouring:
Enhance your natural beauty with non-surgical treatments that target wrinkles, fine lines, and sagging skin. Our services include:

• Acne
• Botox
• Dermal and Lip Fillers
• Pore Reducer
• Rosacea
• Skin Tightening
• Chin Contouring
• Spot Treatment
• Scars
• PRP for Under-Eye

These procedures will help you achieve a youthful, refreshed appearance.

Body

Body Sculpting and Contouring:
Achieve your desired body shape with advanced body sculpting techniques such as:

Skin Tightening
Fat Reduction
Muscle Toning
Scars
Stretchmarks
Cellulite Reduction

We offer personalized treatments to target stubborn fat, cellulite, and loose skin, helping you attain a sculpted and toned physique.

Skin

Advanced Skin Care Treatments:
Revitalize your skin with our range of treatments designed to address various skin concerns, including acne, pigmentation, and aging. Our offerings include

Laser Treatment and Radio Frequency
Skin Tightening
Skin Rejuvenation and Renewal
Tattoo Removal

These treatments promote healthy, radiant skin.

Hair

Laser Hair Removal and Hair Restoration:
Experience smooth, hair-free skin with our laser hair removal services, suitable for all skin types. Additionally, we offer hair restoration treatments for those experiencing hair loss, utilizing the latest technologies to stimulate hair growth and improve hair density.

Weight Loss Management

Comprehensive Weight Loss Programs:
Achieve your weight loss goals with our tailored programs that combine nutritional guidance, exercise plans, and advanced treatments. Our holistic approach ensures sustainable weight loss and improved overall health, helping you feel confident and energized.

Wellness Services

Holistic Wellness and Spa Treatments:
Promote overall well-being with our range of wellness services, including:

Vaginal Tightening
Pelvic Floor Lifting
Hormone Replacement Therapy
Erectile Dysfunction

Our holistic approach addresses physical and mental health, ensuring you feel rejuvenated and balanced.

Consent for Treatment

1st checkbox

I understand that all of the above treatments carry risks including, but not limited to, infection, pain, swelling, asymmetry, scarring, allergic reactions, cold sores, headache for weeks, nodules, bumps, rash, bleeding, burning, tightness, nausea, dizziness, blindness, permanent bruising, diarrhea, upset stomach, warmth, feeling of numbness or swelling of entire body or some areas, rapid heartbeat, chest pain, flushing cramps hives, and breathing problems. I understand that the art of cosmetic injection and aesthetic treatments is not an exact science, that touchup may be needed at total cost, and that there is no guarantee of results. I am not pregnant, nursing, or allergic to any of the components of the treatments. I understand that treatments can take 3-6 months to heal. I have informed the doctor if I take blood thinners or have an infection, scleroderma, asthma, keloid scars, bleeding disorder, eczema, psoriasis, cold sores, kidney or liver disease, cancer, allergies, or prior surgeries.

2nd checkbox

I agree to be responsible for the payment of all services rendered to me, including any pre-purchased packages. I agree to pay the cost of collection, court, and legal fees in the event of non-payment. We do not offer refunds on any services rendered. Aesthetic results vary from person to person. While we do our best to achieve desired outcomes, results cannot be guaranteed. Clients are responsible for any additional treatments needed to achieve desired outcomes. Additionally, we do not offer refunds on prepaid services or refunds to deposits made on services. Funds can be reallocated to a credit OR can be used towards the purchase of different services. We do not offer refunds or exchanges on products. All sales are final. There are no refunds on Gift cards. Gift cards must be presented at the time of purchase. I consent to photographs and digital images being taken and used to evaluate treatment effectiveness, for medical education, training, professional publications or sales purposes. No photographs or digital images revealing my identity will be used without my written consent. If my identity is not revealed, these photographs and digital images may be used, shared, and displayed publicly without my permission.

3rd checkbox

Treatment options, their risks, and benefits are reviewed with me. I consent to this and all subsequent treatments. I agree to follow instructions and comply with aftercare guidelines crucial for healing and preventing scarring and hyperpigmentation. I agree to avoid sun exposure for 1-2 months following treatment or use of SPF 45 or above. I release Evexia Medspa, its staff, and the facility from liability associated with this and subsequent procedures. I have read this form and asked questions, which were completely answered.

Free Text

Acceptance: I acknowledge that I have read and fully understand the above consent to have all procedures and treatments performed

First Name*

Last Name*

Date of Birth*

Today's Date*

Signature

Patient Consent and Information for Body Contouring

Face

Facial Rejuvenation and Contouring:

Body

Body Sculpting and Contouring:

Skin

Advanced Skin Care Treatments:

Hair

Hair

Laser Hair Removal and Hair Restoration:

Weight Loss Management

Comprehensive Weight Loss Programs:

Wellness Services

Holistic Wellness and Spa Treatments:

Consent for Treatment