IF YOU ANSWERED “YES” TO ANY OF THESE QUESTIONS, YOU MAY NOT BE ELIGIBLE FOR THIS TREATMENT

Refund and Credit Policy

1. No refunds will be issued after 30 days from the date of purchase.
2. Any unused balance after 30 days will be applied as a credit.
3. Credits can be used within a maximum of 365 days from the purchase date or until

Radio Frequency (RF): This is a controlled application ofRF heating of deep skin with cooling of the surface skin. It is a newer technology, which heats the underlying skin collagen promoting new collagen formation. The benefits of RF are tightening of loose / sagging skin. This treatment triggers skin regeneration and new collagen is produced. This helps to further tighten skin, resulting in healthier, smoother skin and a more youthful appearance. The therma lift treatment carries with it possible health complications and consequences, which include but not be limited to reddening, swelling, bruising, pigment changes, and burn / blistering. If you bruise easily it is recommended to take Arnica to reduce bruises and the duration of appearance.

Nanofractional Radio Frequency (RF): The nanofractional radio frequency delivers columns of RF energy to the tissue, designed to damage the existing collagen, stimulating the bodies natural healing process. Once the collagen has been damaged the body begins to repair the collagen by replacing the damaged cells with new collagen. The RF also stimulates the body to produce new fibroblasts, the “factories” that create collagen, thus increasing the amount of collagen in the tissue. This wound healing response creates a “resurfacing” or smoother appearance to the skin, plumps fine lines / wrinkles, reduces acne scars, removes pigmented lesions, and textural irregularities of the skin. The nanofractional RF treatments carry with it possible health complications and consequences, which include but are not limited to redness, swelling, blistering, bruising, skin indentations, subcutaneous fat loss, permanent scarring, changes to pigmentation, open sores and infections.

Ultrasonic Fat Cavitation: This is a process which uses Ultrasonic sound waves (Ultrasound) to penetrate epidermis into the subcutaneous fat layer. The treatment which uses 28 Khz to 40 Khz frequency assist with the breakdown of fat cells by creating microbubbles that increases the pressure around the adipocyte and forces it to implode, thus breaking down the adipocyte’s cell membrane. The ultrasound cavitation Treatment carries with it possible health complication and consequences, which include but not be limited to the risk of acemaker bruising, pacemaker failure, birth defects / miscarriage if pregnant, lactation complications, hyperglycemia, hypercholesterolemia, pancreatitis, infection, scarring, and or allergic reaction to any products used, excessive thirst, dehydration, and nausea.

I-Lipo Light: This treatment is an application of a 650nm – 660nm low intensity infrared laser light, which has been shown through extensive research to cause the triglycerides within the fat cells to break down into free fatty acids (FFA) and glycerol which then are released through channels in the fat cells. The fatty acids and glycerol are then transported around the body by the lymphatic system, to tissues that will use them during metabolism to create energy. Independent clinical studies have shown i-Lipo to be, in some cases, comparable to results in liposuction. Non-invasive low level laser therapy has been approved by the FDA. This i-lipo light treatment carries with it possible health complications and consequences, which include but not limited to slight burns / blisters, tenderness, and redding of target area.

EMSculpt: The non-invasive treatment utilizes HIFEM (High-Intensity Focused Electromagnetic) technology to induce powerful muscle contractions not achievable through voluntary contractions. When exposed to strong contractions, the muscle tissue is forced to adapt to such extreme conditions. It responds with a deep remodeling of its inner structure that results in muscle building and sculpting your body. The end results show that muscle fibers are developed and metabolization of fat cells in the treatment area. The emsculpt treatment carries with it possible health complications and consequences, which include but are not limited to muscle ache, tenderness, and redding of target area.

Intense Pulsed Light (IPL): The technology uses a high-powered, hand-held, computer-controlled flashgun to deliver an intense, visible, broad-spectrum pulse of light. Various cutoff filters are used to selectively filter out shorter wavelengths, especially potentially damaging ultraviolet light. The resulting light has a spectral range that targets specific structures and chromophores ie..melanin in hair, melasma, oxyhemoglobin in blood vessels, sun damage, brown spots, discoloration, etc, that are heated to destruction and reabsorbed by the body. IPL shares some similarities with laser treatments, in that they both use light to heat and destroy their targets but unlike lasers that use a single wavelength of light which only treats one condition, IPL uses a broad spectrum that allows it to be used against several conditions. The IPL treatments carry with it possible health complications and consequences, which include but are not limited to burns-blisters, skin redness, tenderness, swelling, and bruising.

BEFORE, DURING, AND AFTER PICTURE: Before, during, and / or after pictures may be taken to document your treatment(s) and progress. These pictures become the sole property of Ultra Body Sculpt, LLC and may only be used for its legitimate record keeping as well as marketing material.

DISCLOSURE: The treatment(s) are a process and subsequent visits may be necessary in order to achieve the desired results. Subsequent visits are subject to additional charges per visit which depends on the amount of work needed. Actual results vary from person to person and Ultra Body Sculpt, LLC ("Ultra Body Sculpt") does not guarantee any specific result. The treatments provided by Ultra Body Sculpt, LLC carry with it possible health complications and consequences stated above.

REFUNDS / RETURNS: Full returns and refunds are accepted on unused packages and unused individual treatments. If a refund is requested on a partially used package, the used treatments will be charged at the current individual treatment rate and the residual amount will be returned to the method of payment used or check. All package deals must be paid in full no longer than 30 days from the day of the purchase.

CANCELLATION / CREDIT CARD POLICY: Ultra Body Sculpt, LLC requires all clients to retain an active credit card on file to secure appointments, pay for services rendered, or pay for missed appointments. It is understood that Ultra Body Sculpt, LLC has a strict 24 hour cancellation policy which reads as follows:

“Ultra Body Sculpt requires a 24 hour cancellation on all appointments. Failure to cancel or reschedule before 24 hours period or 'No Call No Show' to a scheduled appointment will result in one of the following:

• Full service fee charge
• Usage of one of your package treatments
• $100 missed appointment fee

Prior to the 24 hour period you can cancel or reschedule through your client portal online or through the MindBody app.”

By signing this agreement I authorize Ultra Body Sculpt, LLC to charge my credit card on file if I fail to cancel my appointment with in 24 hours OR received a service and fail to pay for the service charge at the time of my appointment.

RELEASE: I recognize that there are certain inherent risks associated with the treatments and I assume full responsibility for personal injury to myself. In exchange for such treatment, I hereby fully release and fully discharge (including its officers, members, owners, employees, and agents) from any and all damages, costs, expenses, liabilities, cause of action, claims and demands of whatever character in law or equity, whether known or unknown, direct or indirect, asserted or unasserted, and whether or not in account of myself or other third parties, or in any way arising out of the above described treatment(s) I have requested Ultra Body Sculpt, LLC to perform. It is the intention of the parties that this agreement binds all parties who’s claims may arise out of, or relate to the treatment or services provided by Ultra Body Sculpt, LLC including any spouse or heirs of the client / patient, and any children, whether born or unborn. Any legal or equitable claim that may arise from participation shall be resolved under Virginia State Law.

INDEMNIFICATION: I agree to indemnify, hold harmless and defend Ultra Body Sculpt, LLC, including its officers, members, owners, employees, and agents against all third party claims, causes of action, damages, judgments, costs or expenses, including attorney’s fees and any other litigation costs, which may in anyway arise from the above described treatment I have requested Ultra Body Sculpt, LLC to perform.

ARBITRATION: It is understood that any dispute arising as to malpractice of any treatment offered at Ultra Body Sculpt shall be decided by a neutral arbitrator. Any arbitration will be governed by the rules of the American Arbitration Association. The fees for the arbitrator will be split pro-rata among the parties and each party will be responsible for their own attorney’s fees and costs. Any action to collect fees from the Client / Patient for the treatments performed may be brought in any court of competent jurisdiction in the Commonwealth of Virginia. In such collection actions, the prevailing party shall be entitled to recover its reasonable attorney’s fees and costs. Filing of any action in any court to collect any fee from Client / Patient shall not waive the right to compel arbitration of any malpractice claim.

BY SIGNING THIS AGREEMENT: I CONFIRM THAT I AM OVER THE AGE OF 18, I UNDERSTAND THAT THE TREATMENT(S) PERFORMED BY ULTRA BODY SCULPT, LLC CAN BE PERMANENT, THAT SUCH TREATMENT(S) HAVE POSSIBLE ADVERSE CONSEQUENCES AND THAT THE TREATMENT(S) ARE FOR COSMETIC PURPOSES ONLY. I CERTIFY THAT I HAVE READ THE ABOVE PARAGRAPHS, FULLY UNDERSTAND THEM AND HEREBY CONSENT TO THE INDICATED PROCEDURES. THIS MEANS THAT I ACCEPT FULL RESPONSIBILITY FOR THESE AND OR ANY OTHER COMPLICATIONS WHICH MAY ARISE AS A RESULT, DURING OR FOLLOWING THE PROCEDURE WHICH IS TO BE PERFORMED AT MY REQUEST. ACCORDING TO THIS AGREEMENT I HEREBY AGREE TO ARBITRATION OF ANY MALPRACTICE CLAIM. I FURTHER UNDERSTAND THAT THE COST OF THESE PROCEDURES ARE NON REFUNDABLE AND THAT BY SIGNING THIS AGREEMENT, I VOLUNTARY SURRENDER CERTAIN LEGAL RIGHTS.