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EmShapeWell Treatment Intake and
Consent Statement:

Do you have kidney failure?
Do you have a lung condition?
Do you have heart disease and/or stents?
Have you had a brain injury or stroke?
Do you have a pacemaker?
Do you have epilepsy?
Do you have any metal implants? (*in consultation)
Do you have a copper IUD?
Are you pregnant or gave birth < 3 months ago?
Do you have a connective tissue or muscle disorder? (*in consultation)
Do you have an active infection or inflammation on the area to be treated?

If any of the medical questions are answered yes, the treatment should not take place! (* With the exception in consultation Statement of Consent/Dr’s Note).

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 afterwards 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 may also occur after treatment. 

Jewelry and piercings, watch, belt, keys, phone, computer, bra with metal clasps and metal objects (think also zipper closure or metal buttons) should be kept away from the equipment and trades. 

Before the treatment I make sure this is removed from my body and during the treatment I do not have a cell phone in my hands

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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