CLIENT DETAILS

Address

MEDICAL HISTORY

Medical History

CLIENT GOALS — TESLACHAIR

TeslaChair Goals

CLIENT GOALS — TESLAFORMER

TeslaFormer Goals

PRACTITIONER ASSESSMENT

TeslaChair & TeslaFormer Information

TeslaChair and TeslaFormer use Functional Magnetic Stimulation (FMS) technology to stimulate muscle contractions.

  • TeslaChair focuses on pelvic floor and core muscles.
  • TeslaFormer focuses on muscle strengthening, toning and conditioning.

EXPECTED RESULTS & LIMITATIONS

Expected Results & Limitations(Required)

Contraindications

  • Pacemaker or implanted electronic device
  • Pregnancy
  • Active cancer unless medically cleared
  • Metal implants in treatment area
  • Recent surgery without medical clearance
  • Epilepsy or seizure disorders
  • Severe cardiac conditions

RISKS & POSSIBLE SIDE EFFECTS

Risks & Possible Side Effects Acknowledged(Required)

PHOTOGRAPHY, VIDEO & MARKETING CONSENT

Photography & Marketing Consent(Required)
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PRIVACY POLICY

Privacy Policy Consent(Required)

Clinical records and photographs may be retained according to Australian law and insurer requirements.

FINANCIAL, REFUND & CANCELLATION POLICY

Completed treatments are non-refundable except where required by Australian Consumer Law. Late cancellations and no-shows may result in fees or loss of deposit.

COMPLAINTS POLICY

Complaints Policy Agreement(Required)

This treatment is cosmetic/wellness based and not intended to diagnose, treat, cure or prevent disease. No verbal or written statement constitutes a guarantee of outcome. Nothing in this agreement excludes rights under Australian Consumer Law. The practitioner reserves the right to refuse or postpone treatment if unsuitable.

PATIENT DECLARATION

Patient Declaration(Required)

TREATMENT RECORD

Device Used

Aftercare

  • Maintain hydration
  • Continue normal activity as tolerated
  • Mild muscle soreness may occur
  • Contact the clinic if unusual symptoms occur

FOLLOW-UP REVIEW

SIGNATURES

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