CLIENT INFORMATION

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MEDICAL HISTORY

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CONSENT & AGREEMENT

I acknowledge that the treatments provided by Bayside Endermologie are for wellness and cosmetic purposes. I have disclosed all necessary medical conditions and allergies. I understand the risks associated with treatments and agree to follow all post-treatment care instructions. I consent to treatment and understand that results may vary.

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Disclaimer: Thank you for choosing Bayside Endermologie. This form is used to collect information about new clients and is for internal use only. All information provided is confidential and will be treated accordingly.

BAYSIDE ENDERMOLOGIE CLIENT INTAKE FORM

CLIENT INFORMATION

MEDICAL HISTORY

CONSENT & AGREEMENT

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