Ultimate Contour™ Consent Form

Ultimate Contour™ Consent Form

Patient & Provider Information

Introduction / Purpose

Ultimate Contour™ is an FDA-cleared, non-invasive radio frequency (RF) device designed for:

  • Temporary body contouring and inch loss

  • Gentle skin tightening and firming

  • Reducing the appearance of stubborn areas, such as arms, abdomen, thighs, and flanks

This treatment provides immediate and measurable results, enhancing body aesthetics without surgery.

Treatment Overview / How It Works

  • Ultimate Contour™ uses RF waves to heat targeted subcutaneous tissue, stimulating collagen and tightening skin

  • Typical session duration: 30–60 minutes per area, depending on treatment site and size

  • Treatment is non-invasive, with no downtime required

  • Multiple sessions may be recommended for optimal results

Contraindications & Warnings

Do not use Ultimate Contour™ if you have:

  • Pregnancy or breastfeeding

  • Pacemakers or implanted electronic devices

  • Open wounds, infections, or skin lesions in treatment area

  • Active cancer or uncontrolled chronic illness

  • Severe cardiovascular or circulatory disorders

Caution should be used for patients with:

  • Sensory impairment, neuropathy, or reduced heat tolerance

  • Recent surgery in the treatment area

Possible Risks / Side Effects

  • Temporary redness, warmth, or mild swelling at the treatment site

  • Tingling, mild discomfort, or transient bruising

  • Rare: burns or blistering if device is improperly used

  • Results vary based on individual physiology, age, lifestyle, and treatment adherence

Pre-Treatment Instructions

  • Ensure treatment area is clean and free from lotions, oils, or jewelry

  • Avoid sunburn or tanning on the treatment area prior to session

  • Inform provider of any underlying health conditions, medications, or recent procedures

During Treatment / Application

  • Patient will be seated or positioned comfortably for treatment

  • Device will be applied to the targeted area, with settings adjusted for patient comfort

  • Patient should report any excessive heat, discomfort, or unusual sensations immediately

  • Provider monitors treatment continuously to ensure safety and efficacy

Post-Treatment / Aftercare

  • Mild redness or warmth may persist for 1–2 hours post-treatment

  • Avoid hot showers, saunas, or strenuous activity for several hours if advised

  • Maintain hydration and follow any specific provider recommendations

  • Schedule follow-up sessions as recommended for optimal results

Patient Responsibilities

  • Follow pre- and post-treatment instructions carefully

  • Report any adverse reactions immediately

  • Attend all recommended sessions for maximum benefit

Acknowledgment & Consent

I acknowledge that:

  • I have read and understood this consent form

  • I understand the benefits, risks, and alternatives of Ultimate Contour™ therapy

  • I consent to the procedure and accept responsibility for my safety

  • I release AI Wellness Center of Excellence, its staff, and affiliates from liability except in cases of gross negligence or willful misconduct

  • I consent to photos or video for educational or promotional purposes, if applicable