LIPO SHOTS CONSENT FORM

LIPO SHOTS

 

PATIENT INFORMATION:
 
MEDICAL HISTORY
 
Procedure Description:

I understand that I am receiving Lipo Shots (also known as lipotropic injections). Lipo Shots are injectable nutrients that support the body’s natural fat metabolism and energy production. They contain a combination of vitamins, amino acids, and compounds such as B12, which help the liver process fats more efficiently.

The injection is administered into a muscle or just under the skin. Lipo Shots are not a weight-loss treatment on their own, but are used to support fat burning, improve energy levels, and enhance results when combined with a healthy diet, hydration, and physical activity. Results vary from person to person, and multiple sessions may be recommended for best results.

Benefits and Risks:

I have been informed that the potential benefits of Lipo Shots may include:

• Support for fat metabolism and liver function
• Increased energy levels and reduced fatigue
• Support for weight-management goals when combined with healthy lifestyle habits
• Improved overall wellness due to vitamin and nutrient support

I understand that Lipo Shots are not a guaranteed weight-loss solution and results vary from person to person.

I understand that there are potential risks and side effects associated with Lipo Shots, including:

• Mild pain, redness, swelling, or bruising at the injection site
• Nausea, headache, or lightheadedness (temporary)
• Allergic reaction to any ingredient in the injection

Aftercare:

I agree to follow all post-treatment instructions provided by the clinician, including hydration, activity guidance, and follow-up schedules. I understand that failure to follow aftercare instructions may affect my results or increase the risk of side effects.

Consent for Treatment:

I hereby consent to receive Lipo Shots at The Abram. I acknowledge that the clinician has explained the procedure, its purpose, potential benefits, and possible risks. I have had the opportunity to ask questions, and all my questions have been answered to my satisfaction. I understand that results vary and that multiple sessions may be recommended.

Release of Liability:

I release The Abram, its staff, and representatives from any liability related to this treatment, except in cases of proven negligence or intentional misconduct.

Human Error Acknowledgment:

I understand that aesthetic treatments are performed by qualified clinicians using professional equipment and established protocols. However, I acknowledge that, as with any procedure involving human involvement, there is a possibility of unintended outcomes due to human or technical error. By signing this consent, I accept this inherent possibility and agree that The Abram and its staff shall not be held liable for minor or unintentional errors occurring during the course of treatment, provided that reasonable care and professional standards are followed.

Photography and Records:

I understand that videos and photos will be taken for medical documentation purposes and will be used only for treatment comparisons and tracking progress milestones.

I agree that all the above information is true and accurate to the best of my knowledge

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