P.R. CELL
2G
Instruction Manual
|
36
Client consent form| 16.
16.
Client consent form
Customer’s name:
Date:
Treatment sites: ________________________________________________
The term cellulite refers to the dimpled, “lumpy-bumpy”, orange peel appearance of the skin that some people have
on their hips, abdomen, thighs, and buttocks. This irregular skin appearance is much more common in women than in
men because of differences in the way fat, muscle, and connective tissue are distributed in men and women's skin.
Hormones and life styles are also contributing factors. The lumpiness of cellulite is caused by fat deposits that push
and distort the connective tissues beneath skin, leading to the characteristic changes in appearance of the skin.
The purpose of this procedure is to diminish the appearance of cellulite in the areas indicated above. The procedure
requires several treatments and may produce some reduction in the appearance of cellulite. The total number of
treatments will vary between individuals.
I duly authorize my therapist to perform the P.R. Cell treatment for the purpose of improving the appearance of cel-
lulite. I am aware that clinical results may vary depending on individual factors, including medical history, client
compliance with pre/post treatment instructions, and individual response to treatment. I have been made aware
that my diet and the amount of exercise I do, will have a major effect on the results of my treatment. If I do not
make an effort to address my dietary requirements and exercise, I am aware that the results achieved may not be
retained. I understand the treatment involves a course of treatments.
I certify that I have been fully informed of the nature and purpose of the procedure, expected outcomes
and possible complications, and I understand that no guarantee can be given as to the final result
obtained. I am fully aware that my condition is of a cosmetic concern and that the decision to proceed is
based solely on my expressed desire to do so.
I understand that it is my personal responsibility to inform the practitioner of the clinic named above of
any changes to my medical history during the course of P.R. Cell treatment sessions and I confirm that should this
occur I shall advise the practitioner of any changes.
I certify that I have been given the opportunity to ask questions, an all questions have been answered to my
satisfaction and that I have fully read and understood the contents of this consent form.
The success of cellulite treatments depends on the type of treatment used but also on the willingness to follow the
recommendations given by my therapist.
The P.R. Cell subdermal vacuum massage smooth’s skin tissue by breaking down the fibrous adhesions that cause
cellulite, stimulating blood and lymphatic circulation, warming up the deeper tissue layers and increasing lipolysis.
Nevertheless, the results of cellulite treatments are dependant on individual metabolic rates. It is therefore important
to understand that the speed at which results are achieved as well as the final outcome can never be predicted with
certaintity. The number of treatment sessions that will be needed will be estimated approximately and may change
during the course of the treatment series. _______________
Healthy eating habits must be adopted. They will not necessarily serve weight loss purposes but will lead
to a nutritional equilibrium that will help in the elimination of the factors causing cellulite. ________________
A daily massage using a loofah or a scorpion glove will help stimulate blood and lymphatic circulation between
treatment sessions. ___________
An exercise program adapted to personal needs is strongly recommended. It will increase your treatment’s success
and benefit your health and well-being. __________
It is very important that you attend scheduled appointments to obtain the best results possible. Two treatments per
week is ideal. ____________
There is no guaranty that results will match those desired. ____________ On occasion there are clients that do not
respond to treatments
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