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Client Consent Form - CelluSculpt EMS training

CelluSculpt EMS Training - Consent Form

Please read carefully and fill out the following form to help us understand your suitability for treatment

Are you experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell?
Have you travelled internationally within the last 14 days?
Have you or any of your household members been diagnosed with COVID-19 WITHIN THE PAST 30 DAYS?
Are you pregnant, breast feeding, or trying to conceive?
Are you currently taking any photosensitizing drugs?
Do you have any sensitivity or allergy to latex?
Do you have any cardiac pacemakers or implanted defibrillators, implanted neurostimulator, electronic implants, pulmonary insufficiency, metal implants?
Do you have have any pre-existing medical conditions or have any questions regarding your treatment, if so please contact Advanced Face and Body prior to your treatment to discuss your suitability for treatment?

CLINIC ADDRESS

Your treatment is up at Suite 603, Level 6, Harley Place, 251 Oxford St, Bondi Junction (diagonally opposite Zara exit of Westfields).  When you arrive, please take a seat in reception and your treatment specialist will be out at your confirmed appointment time.

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Note: If you are driving, please allow more than adequate time for traffic and parking. There is 2hrs free parking opposite in Westfields Mall.

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Thanks for submitting!

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