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Celebration Aesthetic Center
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Body Contour

Please complete all required fields before proceeding.

Client Contact Information

Groupon Information

Please provide your Groupon Voucher Number

Your Groupon voucher will have a redemption code (e.g., ABC123XYZ)

Medical Background

Please answer all medical questions honestly. This information helps us ensure your safety.

General Health

Are you pregnant or trying to become pregnant?
Are you currently nursing/breastfeeding?
Are you epileptic?
Do you have any kind of tumor or cancer?
Do you have melanoma or history of skin cancer?

Cardiovascular

Do you have any heart condition or heart trouble?
Do you have any vascular disease or condition?
Do you have a pacemaker or other electronic implant?
Do you have high blood pressure?
Do you have low blood pressure?
Are you currently taking blood pressure medication?
Do you have thrombosis or thrombophlebitis?
Are you being treated with anticoagulants (blood thinners)?

Organ & Metabolic Health

Do you have any kidney disease?
Do you have any liver disease?
Do you have diabetes?
If yes, is your diabetes controlled with medication?
Do you have thyroid problems?
Do you have high levels of triglycerides?
Do you have high cholesterol?
Do you have or have you had pancreatitis?

Bleeding & Blood Disorders

Do you have hemophilia or a bleeding disorder?
Do you have current or history of internal bleeding?

Implants & Surgeries

Do you have any plastic or bone cement implants?
Do you have any large metal implants?
Do you have an IUD?
Have you had any abdominal operations?
Have you had any surgical procedures in the last 6 months?
Have you undergone an organ transplant?

Skin & Tissue

Do you have any active skin conditions, rashes, or open sores in the treatment area?
Do you have a wound that has not fully healed?
Do you have any acute inflammation?
Do you have any keloids or history of keloid scarring?

Infections & Immune

Do you have any current infection?
Do you have any infectious disease?
Do you have tuberculosis?
Do you have any communicable disease?

Neurological

Do you have any neurological disorder?

Allergies & Sensitivities

Are you allergic to zinc or nickel?
Are you lactose intolerant?
Are you gluten intolerant?

Recent Treatments

Have you had body contouring treatments elsewhere in the last 30 days?

Additional Medical Information

Disclosure and Signature

No Show or Late Fee Policy

Appointment Confirmation: All customers must confirm their appointments 24 hours in advance via the web appointment application. Failure to confirm the appointment may result in the appointment being cancelled.

Credit Card on File: All customers must have a credit card on file. This credit card will be used to charge any applicable no-show or late fees.

Cancellation/Rescheduling: Celebration Aesthetic Center requires a minimum of 24 hours' notice to cancel or reschedule a visit. Cancellations or reschedule requests must be submitted by calling (321) 939-1093 or calling Vanessa at (786) 382-4186.

No-Show Fees: Customers who fail to show up for their scheduled appointment (a "no-show") will automatically be charged the full cost of the scheduled treatment.

Earphone Policy

Since the cubicles amplify sound, we require all customers/clients to use hearing devices such as headphones for their phones and/or tablets. This will ensure that all of our customers/clients are able to enjoy their time at the aesthetic center.

Treatment Details and Risks

This treatment is an ongoing process, and subsequent visits may be necessary to achieve the desired results. Each visit will incur additional charges, which will depend on the amount of work required. Actual results vary from person to person, and Celebration Aesthetic Center does not guarantee any specific outcome.

About the Treatments

  • Ultrasound Cavitation (Fat Reduction): Uses high-power, low-frequency ultrasound (25-28 kHz) to penetrate the skin and assist with the breakdown of fat cells.
  • Radio Frequency (Skin Tightening): Uses radio frequency energy to heat the deeper layers of skin, stimulating collagen production and tightening the skin.
  • Cellulite Treatment: Combines various modalities to reduce the appearance of cellulite by targeting fat deposits and improving skin texture.
  • Lymphatic Massage (Post-Surgical): Manual massage technique to promote lymphatic drainage, reduce swelling, and support healing after surgical procedures.

Potential Risks and Complications

The treatments offered carry potential health risks and complications, which include but are not limited to: risk of kidney, liver, or pacemaker complications; increased risk of birth defects or miscarriage for pregnant women; thyroid damage, ovarian effects, or lactation complications; elevated triglycerides, cholesterol, or pancreatitis; infection, scarring, or allergic reaction to products used; excessive thirst, dehydration, or nausea; temporary redness, swelling, or bruising in treatment area; numbness or sensitivity changes.

After Care

After care instructions must be followed explicitly, whether given in writing or orally. Failure to follow after care instructions may compromise the final results of the treatment.

Photo and Video Consent

Before, during, and after pictures or videos may be taken to document your treatment. Please indicate your preferences below:

Communication Consent

You may opt out of promotional communications at any time by contacting us or clicking unsubscribe in any email.

Release and Indemnification

I acknowledge and understand that the treatments I have requested from Celebration Aesthetic Center carry inherent risks, as outlined previously. In exchange for Celebration Aesthetic Center performing these treatments, I hereby fully release and forever discharge Celebration Aesthetic Center, including its officers, members, owners, employees and agents, from any and all damages, costs, expenses, liabilities, causes of action, claims and demands that may arise.

Arbitration Agreement

It is understood that any dispute arising as to malpractice related to the treatments provided shall be decided by a neutral arbitrator. Any arbitration proceeding will be governed by Florida arbitration statutes. The fees for the arbitrator will be split pro-rata among the parties, and each party will be responsible for their own attorneys' fees and costs.

Signing Agreement

By signing this agreement I confirm that I am over the age of 18, that such procedure has possible adverse consequences and that the procedure is for cosmetic purposes only. I certify that I have read the above paragraphs, fully understand this consent and procedure form and hereby consent to the indicated procedure(s). This means that I accept full responsibility for these and/or any other complications which may arise or result during or following the procedure which is to be performed at my request according to this agreement. I further understand that by signing this agreement, I surrender certain legal rights.