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.

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

Sign Here
Instagram @brow_revamp

Address

Contacts

Brow Revamp X The Abram –

Developed by Vendify
© 2026 All Rights Reserved