• I declare that I have never suffered from any serious systemic diseases, auto-immune disease or severe allergic reaction. I agree to have injections given to me by Ideal Body Clinic. These injections may include one or more of the following substances: Collagen, Hyaluronic acid Preparation {Hylaform, Restylane, etc.}, Botox or equivalent, Corticosteroids, Xylocaine, Teosyal, etc. I have been informed that some of these injectable substances have been reported in the medical literature to have uncommon but possible side effects, such as chronic skin redness, migration persistent deformity, muscle weakness, infection, and atrophy. I have been informed of the advantages and disadvantages of alternate treatments.
  • I release medical staff, and specific technicians from liability associated with the procedure. I certify that I am a competent adult of at least 18 years of age. This consent form is freely and voluntarily executed and shall be binding upon my spouse, relatives, legal representatives, heirs, administrators, successors and assigns. The dedicated camera, iPhones, and iPads are used at the clinic, to capture the client’s photographs for medical reasons. For the security purposes, all the pictures are being uploaded to a secure Google Drive folder, that only four people have access to, and therefore they are required the same level of protection as all other types of confidential information. The images are attempted to be taken with the same standardizing lighting conditions and poses.
  • I hereby grand permission to Ideal Body Clinic, to take and use photographs and/or digital images of me for enhanced safe, quality client care. Results may vary based upon each individual and charges will be applied for extra units or touch ups.
  • I declare that I am not pregnant or breastfeeding.
  • Please note that all products and services provided are not subject to refund. However, they can be exchanged or be credited the precedingly paid amount or the remaining balance.
  • Date Format: MM slash DD slash YYYY