Client Details

Medical History

Do you have or have you ever suffered from: high/low blood pressure, depressive illness, pacemaker, epilepsy/fits, panic attacks, stroke, anxiety, diabetes, migraine/headaches, asthma, heart disease, pregnancy, operation in the last 6 months, phlebitis, infections illness, dysfunction of the nervous system, varicose veins, localised inflammation, bruising, open wounds, scar tissue, swelling, arthritis.

I acknowledge that all information on this consultation sheet above my signature is accurate and correct to the best of my knowledge. I accept full and complete responsibility for my own emotional and/or physical well-being both during and after this treatment. I agree to inform the therapist of any changes to my circumstances during any subsequent treatments. I realise any advice given to me to carry out between treatment is important and I agree to make every effort to carry this out.

THE GENERAL DATA PROTECTION REGULATIONS (GDPR) are changing on the 25TH MAY 2018. In order to comply with these regulations, we need to gain your conse nt to continue to hold your data and inform you of your individual rights under the new legislation. We require you to opt in to be able to hold your personal data, however certain information is required to enable us to fulfill our contractual obligations as detailed below.
The amount of data we will hold on your or your business will include some or all , of the following:

We use your information to allow us to fulfil our obligation to you as a client. You have the right to request a copy of the information we hold for you. If you would like a copy of the information, please contact me on: We would like to continue to correspond with you in the future with information relating to our products by email, telephone post or social media

We may also need to contact you to ensure that all information help is kept accurate and up to date.

“I can confirm I have read and understood and agree with the way my data is used by.”

• -DO drink minimum of ½ your body weight in ounces of water each day at least 1 week prior t o receiving first body wrap. Continue this habit forever!
• -DO ensure that you practice a healthy lifestyle of exercise and proper diet to maintain the inches
  lost. Avoid processed foods, cafeine, white sugar, and white flour.
• -DO ensure that you perform exfoliation at home 3 times per week
• -DO NOT allow yourself to be wrapped if you are pregnant or nursing, have had cancer in the past 2
  years, have a heart condition (specifically conditions requiring Coumadin), or have epilepsy.
• DO NOT use any tanning creams, B vitamins or niacin containing products at least 2 days prior to
  your wrap.
• -DO NOT use any moisturising lotions or creams the day of your wrap
• DO NOT drink anything for 1 hour before your wrap to ensure you will not need to use the restroom.
• -DO NOT shave the day of your wrap.
• DO NOT shower for 6 -8 hours after receiving your body wrap.
• During the wrap, the skin will most likely appear pink or red and will feel warm and tingly. This is
  normal. This is the skin’s natural response to niacin and is a sign of increased circulation.

I hereby acknowledge that the products and services were explained to me in full and I understand the Do’s and Don’ts. I understand that I may have a reaction to one or more of the ingredients in the Contour Cream which may result in a hive type rash.

If under a doctor’s care and I use this information, products and/or services without my doctor’s approval, I am assuming full responsibility from any or all liability.

I am of lawful age and have read and fully understand the contents of this document and the complete terms and conditions herein. This agreement contains the complete agreement between the parties and no other guarantees or refunds will be given on products or
services.

Chin

L upper Arm

R Upper Arm

R Lower Arm

R Lower Arm

Chest

Boob Lift / Reduction

Upper Back

Lower Back

Midriff

Waist

Abdomen

Hips

Bumlift/Reduction

L Upper Thigh

R Upper Thigh

R Mid Thigh

R Lower Thigh

L knee

R knee

L Calf

R Calf

L Ankle

R Ankle

-DO drink minimum of ½ your body weight in ounces of water each day at least 1 week prior to receiving first body wrap. Continue this habit forever!

-DO ensure that you practice a healthy lifestyle of exercise and proper diet to maintain the inches lost. Avoid processed foods, caffeine, white sugar, and white flour.

-DO ensure that you perform exfoliation at home 3 times per week.
-DO NOT allow yourself to be wrapped if you are pr egnant or nursing, have had cancer in the past 2

years, have a heart condition (specifically conditions requiring Coumadin), or have epilepsy.

-DO NOT use any tanning creams, B vitamins or niacin containing products at least 2 days prior to your wrap.

-DO NOT use any moisturising lotions or creams the day of your wrap.

-DO NOT drink anything for 1 hour before your wrap to ensure you will not need to use the restroom.

-DO NOT shave the day of your wrap.

-DO NOT shower for 6 -8 hours after receiving your body wrap.
During the wrap, the skin will most likely appear pink or red and will feel warm and tingly. This is normal. This is the skin’s natural response to niacin and is a sign of increased circulation.