I authorize Bodcor technician to perform Bodcor laser body contouring treatments for the purpose of spot fat reduction and / or improving the appearance of cellulite. I am aware that results may vary depending on individual factors, including, but not limited to, medical history, client compliance with pre/post treatment instructions, and individual bodily response to treatment.

I have been made aware that my diet and the amount of exercise I do, will have a major effect on the results of my treatments. If I do not make an effort to address my dietary requirements and exercise, I am aware that the results achieved may not be retained.

I understand that laser body contouring involves a course of treatments and all sales are final. Services and treatment packages are non-refundable and non-transferable. The fee structure has been fully explained and I understand that I am required to pay for a course of treatments prior to any procedures taking place, unless otherwise negotiated.

I am fully aware that should I wish to cancel the course, the outstanding treatment value is non-refundable. For your convenience, we accept cash, Visa, Master Card, and American Express.

I understand that with some skin types, there is a risk of temporary redness and/or discoloration of the skin localized in the treatment area that can last up to several hours. There is also a possibility of tattoo lightening if located in the treatment area.

I certify that I have been fully informed of the nature and purpose of the procedure, expected outcomes, and possible complications. I understand that no guarantee can be given as to the final result obtained. I am fully aware that my condition is of a cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so.

I understand that it is my personal responsibility to inform the laser technician of Bodcor of any changes to my medical history during the course of laser body contouring treatment sessions. I confirm that should this occur, I shall advise the technician of any changes and make my own best decision for my well being based on the professional advice obtained through my own efforts.

I certify that I have been given the opportunity to ask questions, any questions have been answered to my satisfaction, and that I have fully read and understood the contents of this consent form.

Pre & Post Treatment Instructions

for Maximum Results:

I certify that I have been counseled in the pre and post treatment instructions. I have read and understand the instructions and realize that I must follow these instructions diligently in order to obtain optimum results.

Bodcor Programs & Background:

Should you have any initial concerns you should consult with a doctor to determine if you are a candidate for low level laser therapy. You should ask questions or voice concerns you may have concerning this treatment with a medically trained professional.

If it is determined you are a candidate for this procedure, when arriving for Bodcor treatments there will be a few preliminary steps consisting of: forms, measurements, and photos. Measurements and photos are optional.

Upon beginning Bodcor treatments, the client will need to dress for, or change into clothing that allows the Bodcor technician to apply low level laser panels to treatment areas. From here the treatment will be administered by aiming the Bodcor 4D Lasers, 650/808nm & 940/980nm low intensity lasers on the desired area(s) to be treated.

It is recommended that client should start with a minimum of 10 treatments. There is no guarantee to number of treatments before your body begins responding to this type of therapy. Treatments should be administered no sooner that 2-3 days apart and no further than 3-5 days apart to achieve best results.

Bodcor treatments should be used in conjunction with a healthy diet and exercise to achieve best results. If you are not currently exercising you should consult a health care professional before beginning an exercise program to determine if your body is physically able.

The use of Niacin (Vitamin B3) is also recommended in conjunction with this treatment. Your doctor should review your medical history to determine if the use of Niacin is right for you. Niacin is used to assist your body in removing the fat from your blood stream. Niacin has been known to reduce LDL- cholesterol, reduce triglycerides, and increase HDL cholesterol.

There are few risks associated with low level laser therapy. This treatment is non-invasive and uses low level heat therapy. During treatment no discomfort will be present, the client will not feel the laser, however the light will be visible.

Potential discomfort may come from the heat of the panels. Take note of your personal comfort every few minutes. Laser therapy can be adjusted to fit comfort level of client. Outcome of treatment may result in light redness on the treated areas. Red dots on skin may be visible from the laser therapy resulting in a light sunburn feeling. Adjustment of laser levels can be administered to avoid these outcomes. It is recommended client should communicate with Bodcor technician if feeling any discomfort.

Other potential discomfort may occur if client is taking Niacin. Niacin is a vasodilator, a naturally occurring flush can cause the upper extremities, face, neck, and ears to become red and itch. The experience can be uncomfortable: red, hot and itching skin; this reaction is expected, normal and very helpful in eliminating the liquefied fat. Niacin should be avoided for people who have liver problems, diabetes, ulcers, gout, or taking high blood pressure medications. Tell the Doctor if you are concerned about this supplement.

The only known or anticipated risk with the use of the laser device is that long-term exposure to laser light could cause damage to eyesight. You will be provided with protective eyewear and to avoid this risk, you must wear them throughout the course of your treatment.

(LLLT) Low Level Laser Therapy can cause Hyper-pigmentation.

Some ethnicities are more susceptible to hyper-pigmentation. African American & Native American ethnicities tend to be more sensitive to hyper-pigmentation. To minimize, and/or avoid risk of hyper-pigmentation, starting at lower level laser settings is recommended.

If you are aware that you may be more susceptible to hyper-pigmentation you should notify your Bodcor technician. Your technician can not prevent hyper-pigmentation from happening. But if managed closely this side effect can be significantly reduced and potentially avoided.

Hyper-pigmentation caused by (LLLT) is not likely to create pain. It is still recommended to avoid this side effect as it could become permanent if not managed.

SIGNS OF HYPER-PIGMENTATION: Short term redness is common and swelling of the treated area may occur. Additionally, there may be some bruising.

SKIN COLOR CHANGES: During the healing process, there is a slight possibility that the treated area may become either lighter or darker in color compared to the surrounding skin. This is usually temporary, but, on a rare occasion, it may be permanent.

WOUNDS: Hyper-pigmentation can result in burning, blistering or bleeding of the treated areas. If any of these occur, please see a physician.

BURNS and INFECTION: Infection is a rare possibility whenever the skin surface is disrupted, though proper wound care should prevent this. If signs of infection develop, such as pain, heat or surrounding redness, please stop your treatments until healing has completed.

SCARRING: Scarring is a rare occurrence, but it is a possibility if the skin’s surface is disrupted. To minimize the chances of scarring, it is IMPORTANT that you follow all post-treatment instructions provided by your healthcare physician.

Pregnancy:

Pacemaker and Like-Devices:

Over the years the benefits of low-level laser therapy have become more prominent. Low-level laser therapy has been used by chiropractors for pain management and recently by cosmetic surgeons to emulsify adipose before liposuction with FDA approval. The potential benefit of this treatment is body contouring without surgery.

Problem areas or excess pockets of fat can be targeted, however the most commonly treated areas are the stomach, hips, flanks, and thighs. In clinical trials clients have averaged 4.5 inches lost from there stomach, hips, and thighs. These results do vary and no guarantee is implied or suggested that desired results will be achieved.

This is strictly voluntary cosmetic procedure. No treatment is necessary or required. Alternative treatments, which vary in sensitivity, effect, duration, and invasiveness include: liposuction, mesotherapy, lipodissolve, velasmooth, dieting, exercise, and potential others; which may have there own risks and benefits. You acknowledge this, and realize that the other option to you is do nothing.

By signing below, you certify that this procedure has been explained to you and your satisfaction. Any further questions should be directed to a physician or medically trained professional.

I have reviewed this consent form. My consent and authorization for this procedure are strictly voluntary. By signing the informed consent form I grant authority for a Bodcor technician to perform the described treatment or administer any related treatment as deemed necessary or advisable for my current condition.

The purpose of this procedure, risks, complications, alternative methods of treatment have been fully explained to my satisfaction.

I understand that I may in now way what-so-ever pass blame or hold Bodcor accountable for the outcome of my Bodcor treatments.

No guarantee has been given by anyone as to the results that may be obtained by this treatment. I have read this informed consent and certify that I understand its contents in full. I have had enough time to consider the information and feel I am sufficiently advised to consent to this procedure. I hereby give my consent to have this procedure.

All information regarding the procedure is checked to ensure the accuracy of descriptions. However, we are not always able to control all of the components of the facility, city power outages, etc., and it is possible that an appointment time or procedure may become unavailable due to circumstances beyond our control and for which we do not accept liability.

I further state that I am of lawful age and legally competent to sign this aforementioned release; I understand the terms herein is contractual and not a mere recital; I have signed this document of my own free act.

At Bodcor we place the highest priority on the client’s right to privacy. We recognize the added sensitivities for client’s receiving body sculpting therapy. However, you/the client releases and indemnifies Bodcor and holds harmless Bodcor employee, staff, technician, affiliate, contractor, the corporation or any individual connected in any way to Bodcor to protect your information. Bodcor is purely performing a service at the clients fully willed discretion.

We value your privacy, and are committed to maintaining your security and confidentiality in the use of any information you choose to share with us. We do not disclose identifiable information to any third party without your consent. Further, we do not sell, rent, or otherwise allow the unauthorized outside use of personal information such as names, addresses, phone numbers, or e-mail addresses in our database without your permission.

Client understands and is fully aware Bodcor is a brand representing a 3rd party technology. Bodcor is not a medical company or claiming rights to operate a medical device. Bodcor employee, staff, technician, affiliate, and/or contractors are not medically trained professionals. Bodcor personnel are simply applying treatments and act as an information source.

Client and all parties on the client’s behalf understands they may in no way what-so-ever hold Bodcor employee, staff, technician, affiliate, and/or contractors liable to HIPAA regulations. As Bodcor is in no way what-so-ever associating themselves with The U.S. Department of Health and Human Services entities. Bodcor is only a brand applying a 3rd party technology at the client’s request.

I have been explained and fully understand the procedure, alternatives, and risks to the person or persons whose signature is affixed below. I, the client has verbally agreed to receive Bodcor treatments, understand and contents to all contents of this form.

By submitting this form I state that I am 18 years of age or older, or otherwise have authorized to Consent the above information. I have read or have had explained to me the contents of this form. I understand that information on this form and give my consent to what has been explained to me.

I ACKNOWLEDGE I MAY IN NO WAY WHAT-SO-EVER HOLD BODCOR HARMFUL TO THE OUTCOME OF BODCOR TREATMENTS.

Should I have any further questions or concerns it is my responsibility to obtain additional information to satisfy my needs.

Copies of this form and signature will be valid as if original, also if this document is digitally scanned or signed.

I acknowledge that I will be engaging in unsupervised activities which may lead to personal injury. I agree to assume all responsibility for any personal injury that may occur. I hereby authorize Bodcor staff to act on my behalf, if I am unable to do so, to the best of their ability in an emergency requiring medical attention. I assume personal responsibility for any damages that may result from an injury. I furthermore agree not to hold Bodcor responsible for any injury that might occur during my participation in all activities associated with Bodcor.

Emergency Contact Information: