Pre Appointment Questionnaire

Laser Liposuction is just one of the tools that we can use to help you reach your goals and target specific areas of your body. Once the fat cell is broken down, the lymphatic system transports the free fatty acids and glycerol to the liver for processing to be used as an energy source for your body. It is critical that the dietary and lifestyle changes are made to help support the goals of treatment.

A reduced calorie diet and an exercise program that will help burn 350 – 500 calories post treatment are ideal. Individual results may vary, and it is the responsibility of the client to ensure they are taking the appropriate measures for healthy lifestyle changes to ensure maximum results. Most clients report ½ inch reduction with each treatment and multiple inches can be lost with a series of treatments.

Client education

Drink half your body weight in water three days prior and three days after your procedure. This will help decrease fat storage. Dehydration inhibits kidney function.

Drink half of your body weight in ounces of water.
Diet and exercise will shrink fat cells, but it does NOT eliminate them.

I confirm the following:

Name

Are you over the age of 18:

Are you pregnant or lactating:

Do you have epilepsy:

Do you have a pacemaker:

Do you have Herpes Simplex:

Do you have uncontrolled Hypertension:

Do you have known liver or kidney disorders:

Do you have known thyroid gland dysfunctions:

Do you have a compromised immune system:

Do you have cancer or a history of cancer:

Do you have photosensitivity to sun exposure:

Are you taking any medication that causes photosensitivity:

To help you reach your goals, we have provided a few tips to help achieve the best results. It is important to manage your expectations by adhering to a balanced diet, and exercise program in conjunction with your treatment protocol.

Ensure Your Best Results

Drink plenty of water before and after treatment(s).
Don’t eat 2 to 4 hours prior to treatment(s).
Perform physical activity following each treatment to maximize your results.
Manage caloric intake; excess calories will counteract the laser treatments.
Alcoholic beverages and high sugar content drinks must be avoided before and after treatment(s).

*Do not schedule treatment during your cycle*

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