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Body Sculpting Consent/Intake Form

Please fill out the following form to help us understand your physical condition.

Sex

Please read and initial each of the statements below:

Medical History

Do you have any chronic medical conditions that we should know about?
Are you currently taking any medications?
Do you have any allergies?
Do you have type 1 or type 2 diabetes?
Do you have any known kidney or liver disorders?
Do you have photosensitivity to sun exposure?
Do you currently have cancer?
If yes, are you currently on chemotherapy?
Have you had cancer in the past 12 months?
Do you have any thyroid problems?
Do you have high blood pressure?
Do you have any cardiovascular conditions?
Do you have any medical devices implanted including, but not limited to, hearing aids, a pacemaker, or hormonal pellets?
(Female clients) Are you currently pregnant or nursing?

Alpha Woman Studios Cancellation Policy

Your appointment is very important. We understand that sometimes schedule adjustments are necessary. Therefore, we respectfully request at least 24 hours' notice prior to your scheduled appointment time for cancellations or rescheduling appointments.

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Please notify us by e-mail if your cancellation is outside of our normal business hours or you're unable to reach us by phone at (213) 249-2613.

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Any appointments cancelled/rescheduled or changed without 24 hours notice will result in a charge equal to 50% of the reserved service amount. All "No Shows" will be charged 100% of the reserved service amount.

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Please remember that it is your responsibility to remember your appointment dates and times in order to prevent any missed appointments which result in a cancellation fee. Not receiving an electronic notification of your appointments from us is not sufficient reason to miss an appointment if the original confirmation notification was received timely. 

Alpha Woman Studios Photo & Video Release

I hereby grant and authorize Eva/Jazmine and Alpha Woman Studios the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures, video, and/or audio taken of me to be used in and/or for any lawful promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, press kits, websites, social networking sites and other print or digital communications without payment or any other consideration.

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This authorization extends to all languages, media, formats, and markets now known or later discovered. 

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I waive the right to inspect or approve the finished product wherein my likeness appears, including written or electronic copy. 

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I hereby hold harmless and release Eva, Jazmine, and Alpha Woman Studios from all liability, petitions, and causes of action which I, my heirs, representatives, executors, or any other persons may make while acting on my behalf or on behalf of my estate. 

Thanks for submitting!

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