CryoSkin Consent

"*" indicates required fields

Thank you very much for undergoing a CryoSkin procedure. We would like your procedure to have the maximum result with the maximum safety. Therefore, we kindly ask you to take some time to answer a few questions. The information below is for the CryoSkin operator's record only and will not be misused or passed on to any third parties, unless with authorization of the client.
Name*
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Permanent Contraindications for CryoSlimming or CryoToning/CryoFacial

If you have a specific condition that is not mentioned in the lists below, please inform your CryoSkin operator. Your CryoSkin operator might ask you for a medical consent or might refuse to conduct a CryoSlimming or CryoToning/CryoFacial as a precaution.
Do you suffer from cryoglobulinemia auto-immune disease?*
Do you suffer from allergies to cold (irritated skin, Raynaud syndrome)?*
Do you have any serious blood circulation conditions (phlebitis, thrombosis, severe varicose veins)?*
CryoSlimming or CryoToning are possible on spider veins without the initial warm phase
Do you have a hernia on the concerned area?*
Do you suffer from asteoporosis (level 3)?*
A cryofacial is possible on people suffering from asteoporosis.

Temporary Contraindications for CryoSlimming or CryoToning/CryoFacial

Are you under 18 years old?*
A session is possible for 16+ with parents consent.
Are you being treated for cancer at the moment?*
Are you pregnant or breast feeding?*
No CryoSlimming or CryoToning until the menses return or the end of breastfeeding. A CryoFacial is possible on pregnant/breastfeeding women.
Have you any skin condition on the concerned area?*
Wound, scar (less than 3 months), eczema, etc.
Have you recently had body piercing/tattoos on the concerned area?*
A procedure is possible is the area has completely healed; the piercing must be removed.

Contraindications for CryoSlimming (fat freezing) Only

Do you have any serious kidney or liver conditions?*
Are you diabetic?*
Session is possible after medical advice, with a session every 3 weeks
Do you have any implanted devices (Pacemaker, defibrillator...)?*
Session is possible after medical advice
Have you had an organ transplant? Session is possible after medical advice*
Please note that CryoSlimming is a technique to reduce localized body fat and loose inches/cm, it is not a solution to lose weight. It is possible to do a CryoSlimming session every 2 weeks (time necessary for the kidneys to eliminate the waste), all body zones included (it is not possible for example to do within 2 weeks a zone different that the first one). Please note that CryoSlimming is forbidden on the breasts and on the face. Sometimes localized redness can occur during the procedure, or the client might feel some discomfort or itching without consequences and sometimes due to the reactions with certain cosmetic products. These side effects usually disappear soon after the session. It is necessary to avoid eating sugar (including carbs), 2 hours before and 2 hours after a CryoSlimming session as sugar gives energy to the fat cells which are then more resistant to the procedure. After the session, it is recommended to drink a lot of water to drain the waste. Clients must follow a healthy diet and exercise to maintain results.

Contraindications for CryoToning/CryoFacial Only

Have you had Botox/hyaluronic fillers in the last 3 months?*
(CryoFacial Only)
Do you have any sinus sensitivity?*
(CryoFacial Only)
Do you have breast implants?*
(CryoToning targeting the breasts only)
Please note that it is possible to do a CryoToning/CryoFacial session every week on the same zone. It is possible to do more than one session per week on different zones.

For Marketing Use

I consent to the use of photos taken.*
I consent to the use of photos taken, not showing my face.*
I consent to the use of photos taken, not showing my face but not my eyes.*
I consent to the use of photos taken, showing parts of my face.*
I do not consent to any use of photos taken.*

Acknowledgment

Disclaimer: I declare that I have read, understood, and answered the questions to the best of my knowledge. I have no known medical condition or allergies that may affect or induce a harmful reaction from a CryoSlimming (fat freezing) or a CryoToning/CryoFacial.
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