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Consent Form: Cool Sculpture

About Cool Sculpture

CoolSculpture treatment:                                                                                               

CoolSculpture procedure uses a highly controlled cooling technology that can safely and effectively reduce and eliminate fat cells to help contour a specific area on the body.

Someone who is overweight can expect to see less visible improvement than someone who has smaller fat deposits.  This is not a weight-loss solution and it does not replace traditional methods such as healthy diet and daily exercise.

More than one treatment may be needed, depending on the size of the treatment area and the desired outcome.  As with most procedures, visible results will vary from person to person.

What to expect:

  • A sensation of deep pulling, tugging and pinching.
  • Experience intense stinging, tingling, aching or cramping as the treatment begins.
  • Experience an uncomfortable cold sensation that typically subsides once the area becomes numb within 10-12 minutes after the procedure begins.

If an excessively painful sensation is felt during the procedure please notify your technician immediately.

Possible risks:

  • You may feel deep itching, tingling, numbness, tenderness to the touch, aching and soreness in the treated area.
  • You may also feel a sense of nausea or dizziness as your body naturally warms and sensation returns to your treatment area. These are all normal reactions that typically resolve within minutes.
  • Bruising, strong cramping and muscle spasms are typical reactions after treatment. These could last up to 2 weeks or more.
  • You may experience extreme freeze burn, extreme blisters, or darker skin colour change of the treatment area.
  • Other unknown side effects may also occur.

You may immediately return to your normal activities, including work or exercise.

You may start to see changes as early as three weeks after CoolSculpting, and you will experience the most dramatic results after 6-12 weeks. Your body will continue to naturally process the treated fat cells from your body for approximately four months after your procedure.

Please Complete

Please complete required fields
Please select Yes or No
I hereby authorise and direct any associates or assistants of Bodyvision Clinic to perform CoolSculpture procedure.

I fully understand that this treatment is purely elective and not medically necessary.

I understand that results will vary from person to person. I understand that I may require multiple treatments. I fully understand that results are not guaranteed.

I also understand that I need to maintain a healthy diet and exercise regime throughout my treatments to achieve the best results.

By signing this consent form, I confirm I am over the age of 18 and have read and fully understand all its contents.

I have had the opportunity to ask questions and receive answers regarding CoolSculpture procedure.

I agree to pay in full for our discussed treatment and understand that there will be no refunds for any performed services.

I understand that I have the right to refuse the proposed procedure at any time prior to its performance.