Body Toning – Tesla Machine Comprehensive Consent and Concern Form

Client Information

Full Name *

Date of birth *

Gender *

Address

Street Address

City

Postal code

Phone Number *

Email Address *

Emergency Contact Name *

Emergency Contact Phone *

Medical History

Are you currently under medical supervision or taking medications? *

Yes

No

If yes, please provide details: *

Have you had recent cosmetic treatments in the area targeted? *

Yes

No

If yes, please let us know: *

Treatment Goals and History

Let us know : *

Have you had a Tesla body toning treatment before? *

What are your desired outcomes for this treatment ? *

Treatment Information & Contraindications

Do you currently have any open wounds, infections, or irritation in the treatment area? *

Yes

No

Do you have any metal plates, screws, or electronic implants in the body? *

Yes

No

Do you experience pain, numbness, or tingling in the area to be treated? *

Yes

No

Have you engaged in intense physical exercise within 24 hours of this session? *

Yes

No

Risks, Side Effects, and Acknowledgements

Please read and initial each statement regrading Tesla Body Sculptor: *

I understand that Tesla Body Toning uses electromagnetic stimulation to contract muscles.

I understand that this treatment is non-invasive and may improve muscle tone and body contour.

I acknowledge that some temporary discomfort, tingling, redness, or muscle soreness may occur.

I understand that this is not a weight loss procedure and results vary based on individual factors.

I confirm that I have disclosed any health concerns that may affect the treatment outcome.

I will follow all pre- and post-treatment instructions provided by the clinic.

I agree to notify the clinic immediately if I experience unusual symptoms or discomfort.

I consent to the use of clinical photos for treatment documentation. These will not be shared without consent.

Client Declaration and Consent

I declare that the information I have provided is accurate and complete.

I understand the nature, purpose, and possible risks associated with Tesla Body Toning.

I confirm that I have had the opportunity to ask questions and all were answered to my satisfaction.

I voluntarily consent to receive this treatment at Idens Laser Clinic.

By signing below, I confirm that I have read and understood the information provided and consent to proceed with the treatment.

Client Signature: *

Clear

Date: *

Practitioner Name (Print): *

Practitioner Signature: *

Clear

Date: *

I agree to terms & conditions provided by the company.

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Body Toning – Tesla Machine Comprehensive Consent and Concern Form

Treatment Goals and History

Treatment Information & Contraindications

Risks, Side Effects, and Acknowledgements

Client Declaration and Consent

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