Consent to Treatment

"*" indicates required fields

Patient Information

Patient Name*

Consent to Treatment

This consent to treatment form explains the risks and benefits of the All Services By TNP . Patient understands all of the following:
Consent*

Conditions Preventing Treatment

Patient agrees (by initialing) that all of the following are true:
Consent*
Consent*
Consent*
Consent*
Consent*

By signing below, patient agrees that provider listed above may perform the Diamond Series Dual Frequency procedure for the purpose of aesthetic body contouring and girth loss. Patient understands and accepts the risks listed above, and agrees that all information provided on this form is true and correct to the best of patient's knowledge.
Name
Signature Date*
This field is for validation purposes and should be left unchanged.