Body Balance Sculpting

Client Consultation and Health Declaration Form

Thank you for your interest in Body Balance Sculpting!

We’re thrilled to help you take the first step toward achieving your body goals. This consultation form is designed to evaluate whether you meet the requirements for our non-invasive body sculpting treatments.

Your responses will allow us to assess your health history, lifestyle habits, and treatment goals to determine the safest and most effective options for you.

Please answer each question honestly and completely. The information you provide will remain confidential and will be used only to customize your treatment plan and ensure your safety and best possible results.

Once submitted, our team will review your responses and contact you to discuss your eligibility, recommendations, and the next steps toward your personalized sculpting journey.

Medical History

Body Sculpting Goals

Consent & Acknowledgment

By signing below, I confirm and certify that the information and medical history provided is complete and accurate to the best of my knowledge.

I understand that Body Balance Sculpting provides non-medical, non-invasive aesthetic and wellness services and does not diagnose, treat, cure, or prevent any medical condition.

I acknowledge that certain medical conditions or contraindications may require services to be modified, postponed, or declined for safety reasons.

I understand that failure to disclose relevant health information may increase risk and may result in refusal of service.

I acknowledge that results vary per individual and are influenced by lifestyle, diet and consistency.

I voluntarily consent to receive services and accept responsibility for communicating any changes to my health status prior to each appointment.

I understand and accept that my electronic signature will be as valid as a handwritten signature and considered original to the extent by applicable law.