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Laser Lipo Treatment Agreement

Body Contouring Treatments

Fees

All costs are payable in-full prior to initial treatment and are nonrefundable. Costs do not include future visits unless expressed otherwise. Payment for entire package price (6, 9, 12 or 15 sessions) must be made by first visit to receive package discount. Scheduling for all treatments will be made at the first appointment. A 24 hour cancellation is required or you will forfeit treatment(s) and payments for that appointment.

Medical Background (Check YES to all that apply)

IF YOU ANSWERED "YES" TO ANY OF THE ABOVE QUESTIONS, YOU MAY NOT BE ELIGIBLE FOR TREATMENT. 

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