The equipment we use safely and effectively uses thermal shock to naturally destroy fat cells without any damage to the skin. The Cryoskin breaks down fat cells, which your body naturally flushes out through the bloodstream and then the lymphatic system in the days to weeks following the session. Cryoskin also helps to reduce the appearance of cellulite, fine lines and wrinkles by stimulating collagen and elastin production while tightening muscles. Cryoskin is also beneficial for facial toning and lifting. Protocols will be discussed and or adjusted during consultation based on recommendations and guest needs.

I understand that results may vary depending on individual factors including but not limited to medical history, prior treatments of area being treated, skin type, medication, hormones, patient compliance with pre/post session instructions and individual response to treatment. I understand that I must maintain good dietary habits, have sufficient water intake and participate in light physical activity as well as comply with other items outlined during consultation.

Photos will be obtained for records. If pictures are used for education and marketing purposes,, all identifying marks will be cropped or removed, unless the Cryoskin 3.0 treatment is done on the face. We only use the facial photo with your permission.

The completed form is for informational purposes only. Heavenly Body Studio & Boutique and its staff are not medical professionals, and do not claim to be. We are experts on the equipment we use and hold the highest standards of safety, customer service and education. These products and equipment have not been tested or proved by the FDA or any other government agency for the treatment of any illness or disease. Use at your own risk.

Clients receiving Cryoskin Treatments, please read the following information.  

By signing below you are stating that you acknowledge that you understand that you can not have Cryoskin treatments in areas where you have had the following treatments and you do not have the following condtions

o   Botox/Fillers ( Last 3 months)    

o   Surgery ( last 3 months)

o   Breast Implants or Breast Feeding

o   Pregnant

o   HIV/AIDS

o   Cancer

o   Cold sensitivity (Reynaud’s)

o   In Vitro Fertilization (IVF)

o   Open or infected wounds

o   Scar tissue,Tattos, or irremovable piercings (in the area to be treated)

o   Eczema, rashes, or dermatitis

o   Circulation or heart disorders

o   Liver or kidney disease

o   Diabetes (type 1 insulin dependent)

o   Foreign ointments or lotions on the skin

o   MS, Parkinsons, ALS, Neuropathy, or Lymphatic Disorders

Read the following YES/No questions.  If you need to answer YES to any of the questions please inform us at the bottom of this section. Please also inform us on the day of you appointment so that we can discuss it. 

• Do you have cancer or a history of cancer?                                              YES/NO

• Are you undergoing active chemotherapy?                                              YES/NO

• Do you suffer from serious kidney disease?                                             YES/NO

• Are you on dialysis?                                                                                      YES/NO

• Do you have any lymphatic drainage disorders?                                    YES/NO

• Have you had Botox or filler within 90 days?                                          YES/NO

• Do you suffer from Type 1 Diabetes?                                                       YES/NO

• Do you have loss of sensation in your extremities?                               YES/NO

• Are you pregnant, lactating or undergoing IVF?                                     YES/NO

• Do you suffer from Cold sensitivity or Reynauds?                                  YES/NO

• Recent surgery? (last 3 months)                                                                YES/NO

• Do you have Eczema, Rashes, or dermatitis?                                          YES/NO

• Have you had breast augmentation or any other elective surgery?   YES/NO

• Do you currently have any open or infected wounds?                          YES/NO

• Do you have any mesh inserts?                                                                  YES/NO

• Are you currently taking hormone therapy of any kind?                       YES/NO

• Do you have MS, Parkinson's, ALS, Neuropathy,               YES/NO

• Do you have HIV/AIDS?                          YES/NO

• Do you suffer from Lymphatic Disorders?                  YES/NO

If you are receiving Lipo Laser, an LED Facial, an infrared sauna session, or Muscle Stimulation please read the following information.  Clients with the conditions listed below are not allowed to have these services.  You must inform us if this applies to you.

Infrared Sauna Contraindications

• Skin diseases or burns
• Splanchnic diseases
• Require a heart defibrillator or use other implantable devices
• Heart disease
• Broken bones
• Malignancy
• Recent surgery
• Osteoporosis
• Abnormal blood pressure
• Currently pregnant, may be pregnant, or are breastfeeding
• Anhidrosis
• Cancer
• Implants including metal, silicone, breast implants, etc.

Lipo Laser Contraindications – Epilepsy, Kidney/Renal Failure, Liver Failure, Hypertriglyceridemia & Hypercholesterolemia, Thyroid Conditions.  Pregnant or breastfeeding may need to consult your physician.

LED Facials Contraindications– Epilepsy, Light sensitivity, If you use a topical steroid, Thyroid Conditions, treatment involving cortisone, steroids, or photosensitive drugs and hers such as psoralen and st. john’s wort. Pregnant or breastfeeding need to ask doctor. 

Muscle Stimulation Contraindications – using anticoagulant drugs, patients who are fasting for long periods of time, recent traumas or bone fractures, recent hemorrhage, heart diseases, and varicose veins. Pregnant or breast feeding ask doctor. 

Facial Scrub/Face Mask/Facial - allergy to any of the ingredients used in the products.  It is up to you to let us know about any allergy you have to cosmetics and or any of the ingredients in the products we use. 

If you have any of these conditions but proceed with the service, Heavenly Body Studio will not be held responsible for any adverse affects from the services we provide. 

By signing below you are stating that Heavenly Body Studio & Boutique will not be held responsible if you have any allergic reaction to any of the ingredients used in the products used in our office.  

By signing below I am stating that the statements above are factual to my knowledge. I understand that any procedure involves risk. Risks may include redness, swelling, irritation, skin reaction, or increased heart rate. Some may experience delays onset muscle soreness from treatments on the stomach due to unintentionally engaging the abdominals, which disappear later the same day. I understand that each person has a different reaction to Cryoskin. The risks, benefits, and possible results have been explained to me. I have been provided the opportunity to ask questions and receive satisfactory responses.

By engaging Heavenly Body Studio & Boutique (for the purposes hereof referred to together herein as the “Company”) to provide cryoskin, infrared sauna and related services (“Services”) and using the Company’s equipment and facilities in relation thereto, I hereby acknowledge on behalf of myself, my heirs, personal representatives and/or assigns, that there are certain inherent risks and dangers associated with receiving Services and my use of the Company’s equipment and facilities when it comes to my medical history. At all times, I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions given to me by staff.  If in the subjective opinion of the Company’s staff, I would be at physical risk in receiving Services, I understand and agree that I may be denied access to Services until I furnish the Company with an opinion letter from my medical doctor, at my sole cost and expense, specifically addressing the Company’s concerns and stating that the Company’s concerns are unfounded. 

For best results following a Lipo Laser and/or Cryo session, do not eat sugar 2 hours before and after the session. Be sure to drink a lot of water before and after the session as well.

• If possible, avoid all kind of sugar for 4 – 5 hours before and after the cryo session. 2 hours is the recommended time for best results.

• This applies to all kind of sugars (pasta, rice, bread, cereals…) and of
course simple starches and sugars.

• The cold weakens and retracts the adipocyte [fat storage cell]. Consuming sugar will return immediate energy to these cells, so the apoptosis [cell death] effect will be less efficient and can even be canceled.

• The lymphatic system takes 15 days to complete an entire cycle. Therefore, results will improve over the 2 weeks following the session. 

• Avoid exercise directly before a session. It will be harder to cool the body down and complete the slimming effectively.

• For best results, maintain the best possible diet and lifestyle to accompany the treatment (drink plenty of water).  We recommend you drink a 1 1/2 liters.

After Care:

• Drink a minimum of 1.5L of water or our tea sold in the boutique  per day for 14 days following a CryoSlimming session.

• Follow a balanced lifestyle, with a healthy diet and exercise routine for the best results.

• If desired, you may incorporate detox treatments into your routine such as:
  + Infrared sauna (which we can provide)+ Whole Body Cryotherapy + Lymphatic Drainage Massage + Compression

For best results, these treatments should be done at least 72 hours after your CryoSlimming session.

Your participation in the Services will expose you to extremely cold temperatures. I have read this Assumption of Risk, Waiver, and Release, fully understand its terms, and understand that I am giving up substantial rights including my right to sue the Company under certain circumstances. I acknowledge that I am signing this waiver freely and voluntarily. The term of this waiver is indefinite.

I acknowledge that I have been urged to avoid bringing valuables into and onto the Company’s facilities and the Company shall not be liable for the loss of, theft of, or damage to my personal property, including items left in lockers, bathrooms, or anywhere else in the Company’s facilities. I acknowledge that no portion of any fees paid by me is in consideration for the safeguarding of valuables.

By signing below, I acknowledge and certify that I have read and understand the “Consent, Release and Indemnity” agreement for this treatment, and that I am signing it voluntarily. Should any pain or discomfort occur, I will immediately notify the technician. I understand that I must be at least 18 years old to participate in this treatment. I understand that all sales are final and refunds are not permitted.