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icoone Laser Treatment Intake and
Consent Statement:

To suffer from the following diseases: (Check any that apply)
To be in one of the following conditions: (Check any that apply)
To be under one of the following drug therapies: (Check any that apply)
To have had, in the last 6 months, the following medical intervention: (Check any that apply)

I am aware of the nature, purpose and expected results of the proposed treatment. I have no guarantee of the final outcome of the treatment.


I understand that these treatments should take place with a healthy diet and active lifestyle.

I informed the practitioner of my illness, medication use and any hypersensitivities. The practitioner has advised me about reactions afterward and how to deal with them.

I undergo the treatment at my own risk and know that I cannot hold my practitioner responsible for any physical injury.

It is possible that the treated area may feel temporarily sensitive or hardened. Muscle pain and/or bruising may also occur after treatment.

I will reschedule/cancel my appointment at least 48 hours in advance. If not canceled in time, 50% of the treatment will be charged or I can forfeit that session.

When purchasing a course of treatment, I am not entitled to a return of my money if I decide to end the course prematurely.

I have verbally received and understand the above information, the statements, and the customer advice and agree to it.

I INDEMNIFY Frisco Body Contouring and Weight loss from any liability arising from the health conditions not specified in this form.

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