HBW Medical Questionnaire
Please fill out the following form to help us understand your physical condition.

First Name

Email Address

Last Name

City & State - Residence

Are you over 250lbs? If so, you may not be suitable for our services. Please reach out to Fran via email or over text.

Yes

Do you have any health or serious illnesses such as diabetes, cancer, kidney problems, auto immune diease, epilepsy, gastric ulcers, cardiovascular conditions or currently pregnant? Are you allergic to any creams or essential oils? Are you claustrophobic?

Yes

If you have answered yes to this question, please elaborate below:

Do you grant HBW permission to take before and after photos for social media purposes (e.g, Instagram, Facebook, Website, etc.) during your session?

Yes

Full Name - Electronic Signature

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

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HBW Consent Form

Infrared Body Wraps, Vibration Therapy, Butt Cupping, Wood Therapy, Ice Body Sculpting & Body Sculpting Treatments.

First Name

Last Name

I consent to receiving the requested body sculpting, wood therapy, infrared body wraps, ice body sculpting, butt cupping or vibration therapy services and also understand that results vary from person to person.

I understand that I am unable to partake in select body sculpting services such as but not limited to cavitation and rf skin tightening if I have any of the following conditions: Cancer, Cardiovascular Disease, Metal Implants, Pregnant, Breast Feeding, or Skin Allergies.

I understand that I may experience redness, brusing, skin irritation, swelling, increasing heart rate or light headed/dizzy. I will also inform any HBW staff if I am feeling claustrophobic.

I have read and consent to the statements above. I understand the risks associated with the body sculpting, infrared body wraps, ice sculpting, butt cupping, vibration therapy treatments and will NOT hold the technican nor associated company, HOT BODY WRAP, LLC, responsible or liable for any injuries, side effects, or damages that may occur from recieving the treatments.

Any appointment cancellation with less than 24-hours notice are subject to a cancellation fee amounting to 100% of the cost of the scheduled appointment. It would be considered a "Late Cancellation". You can call, text, leave a voicemail or email us 24-hours prior stating that you cannot commit to your scheduled appointment and that you need to reschedule. Online bookings require a full payment using credit or debit card. All service sales are non-refundable. When you book an appointment with us online or in person, you are agreeing to these policies.

Full Name - Electronic Signature

Date

Thanks for submitting!

HBW Medical Questionnaire Please fill out the following form to help us understand your physical condition.

KEEP GOING. YOU HAVE ONE MORE FORM TO COMPLETE!

HBW Consent Form

HBW Medical Questionnaire
Please fill out the following form to help us understand your physical condition.