EMS (Elector Muscle Stimulation) uses faradic current to tighten and tone muscles for lifting and slimming. It may visibly lift, firm, and contour muscles attached to the skin. Certain medical conditions could render this treatment inappropriate or dangerous to perform. Please read through each condition below carefully and check if you currently have or have had any of the conditions.  If you don’t understand anything, please ask your esthetician before continuing.

Medical Background

Precautions

• I understand that the EMS treatment is not recommended if I am pregnant, breast feeding, have a lymphatic disorder, acute illness, metal implants, pacemaker, infection, cardiovascular disease, epilepsy or seizures, open wounds or are currently being treated for active cancer.

• I understand that neither office personnel of Bossy Glam Studio Inc nor this agreement provides a guarantee of results. This agreement deals solely with the services rendered and the fees to be paid for the care as provided. Your payment obligation is not contingent upon the outcome of services.

• I understand and acknowledge that payments for the above services are non-refundable.

• I understand that this treatment can help eliminate fat, tone muscles and tighten skin. However, I understand that it is not intended as a weight loss solution.

• I understand that to achieve maximum results, I will need further treatments. But I also understand there are no guaranteed results.

• I further agree to provide Bossy Glam Studio Inc 24 hour notice of a cancellation or change in appointment time, or I will forfeit a treatment off my package and/or my deposit

• There are no refunds if I am reacting to a treatment and decide to stop treatments.

• Should I decide to add a treatment, the additional treatment will be considered a separate treatment.

• I agree to inform and notify immediately Bossy Glam Studio Inc should information regarding my health history past and present, change.

• I agree that I have answered all the questions about myself and my health history to the best of my abilities and knowledge.

• I certify that the information on my intake form(s) are true, and acknowledge that any misrepresentation of my health history may result in injury or death. If any of the information provided by me is false, misleading or undisclosed, I agree that Bossy Glam Studio Inc will not be held liable.

I have completed this form to the best of my ability & knowledge, & agree to inform my esthetician of any changes to the information listed on all pages of this intake form. I have been informed of & understand the contradictions to the requested treatments & agree that I do not have any condition(s) that would make the requested treatment unsuitable. I will inform my esthetician of any discomfort I may experience during said treatment to allow them to adjust accordingly. I agree to waive all liabilities toward my esthetician and Bossy Glam Studio Inc. for any injury or damages incurred due to any misrepresentation of my health history  I agree that I have read and understand all of the above. 

I agree that I am at least 18 years of age, and agree to receive treatment at Bossy Glam Studio Inc