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Services
Primary Care
Functional Medicine
Post Op Care
IV Therapy
Mobile
Policies
Training
Shop
Contact Us
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Services
Primary Care
Functional Medicine
Post Op Care
IV Therapy
Mobile
Policies
Training
Shop
Contact Us
Services
Primary Care
Functional Medicine
Post Op Care
IV Therapy
Mobile
Policies
Training
Shop
Contact Us
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Do you have any allergies to food or medication?
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Are you taking any medication(s) or vitamin(s)?
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List all medication(s) or vitamin(s)
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Do you have any pre-existing health issues/diseases?
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Please explain past medical history
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Are your pregnant or breast feeding?
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What service are you interested in?
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Post Op Care
IV Therapy
Post Op Care: Select all that apply:
*
Lymphatic Massage
Suture Removal
Drain Removal
Seroma Drainage
Advanced Post Op Care
Pain Shot
Keloid Shot
BBL-PRP
IV Hydration
*
B12 (IM)
Pure
Immunity
Energy
Healing
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Name of Surgeon
*
Country or State
*
Date of procedure(s)
*
Type of procedure(s)
*
Liposuction
Arm Lipo
Chin Lipo
Inner Thigh Lipo
BBL (Fat Transfer)
Tummy Tuck
Breast Augmentation
Breast Lift
Arm Lift
Ab Etch
J Plasma
Panniculectomy
Other
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Please explain what other procedure(s) you had
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Post Op Care Consent: I voluntarily consent to receive post-operative care services from BODY BY YASHI LLC, which may include, but are not limited to, Manual Lymphatic Drainage (MLD), seroma management, drain removal, suture or staple removal (when appropriate), Platelet-Rich Plasma (PRP) therapy, scar management, and other supportive post-surgical treatments. I understand that these services are intended to support the body's natural healing process following surgery and are not intended to diagnose, treat, cure, or prevent any disease or replace the care and recommendations of my surgeon or other healthcare provider. I acknowledge that I am at least 18 years of age and legally competent to consent to treatment. I understand that healing and treatment outcomes vary among individuals and that no guarantees or warranties have been made regarding the results of any treatment. I understand that potential risks may include, but are not limited to, soreness, tenderness, bruising, swelling, redness, skin sensitivity, temporary changes in skin pigmentation, discomfort during or after treatment, infection, delayed healing, and unsatisfactory results. Although reasonable precautions are taken, I understand that not all risks or complications can be anticipated. I certify that I have fully disclosed my medical history, medications, allergies, prior surgeries, and any medical conditions that may affect my treatment or healing, and I agree to notify BODY BY YASHI LLC of any changes in my health before future treatments. I understand that physician clearance may be required prior to treatment if deemed medically necessary. I consent to photographs of the treatment area for documentation in my medical record, and I understand that separate written authorization will be obtained before any photographs are used for marketing or educational purposes. I voluntarily assume all known and unknown risks associated with these treatments and, to the fullest extent permitted by law, release and hold harmless BODY BY YASHI LLC, its owners, employees, agents, and independent contractors from any claims, liabilities, damages, or expenses arising out of or relating to the services provided, except where prohibited by law or resulting from gross negligence or willful misconduct. I acknowledge that I have had the opportunity to ask questions, that all of my questions have been answered to my satisfaction, that I understand the nature, risks, benefits, and limitations of the proposed treatments, and that I voluntarily consent to receive post-operative care services from BODY BY YASHI LLC. I further understand that these services are not a substitute for follow-up care with my surgeon and that I should promptly contact my surgeon or seek emergency medical attention if I experience severe pain, excessive bleeding, fever, chest pain, shortness of breath, or any other concerning symptoms following surgery or treatment.
*
I agree
IV/IM Therapy: I voluntarily consent to receive intravenous (IV) therapy from BODY BY YASHI LLC. I understand that IV therapy involves the administration of fluids, vitamins, minerals, electrolytes, medications, amino acids, antioxidants, and other approved injectable therapies directly into a vein to provide hydration and/or support my individualized treatment plan. I acknowledge that I have fully disclosed my complete medical history, current medications, allergies, and whether I am pregnant, may be pregnant, or am breastfeeding, as well as any medical conditions that may affect my eligibility for treatment. I understand that potential risks and side effects may include, but are not limited to, pain or discomfort at the injection site, bruising, swelling, bleeding, infection, inflammation of the vein (phlebitis), infiltration, extravasation (leakage of IV fluid into surrounding tissue), allergic reaction, dizziness, fainting, nausea, headache, fluid overload, electrolyte imbalance, and, in rare cases, serious complications requiring emergency medical care. Although reasonable precautions are taken to minimize these risks, I understand that not all complications can be anticipated. I acknowledge that treatment outcomes vary among individuals and that no guarantees or warranties have been made regarding the effectiveness or results of IV therapy. I understand that I may refuse or discontinue treatment at any time and that BODY BY YASHI LLC reserves the right to discontinue treatment if it is determined that continuation would not be in my best medical interest. In the event of an adverse reaction or medical emergency, I authorize BODY BY YASHI LLC to initiate appropriate emergency measures, including contacting Emergency Medical Services (911), if deemed medically necessary. I have had the opportunity to ask questions, and all of my questions have been answered to my satisfaction. I understand the nature, risks, benefits, and alternatives to IV therapy, voluntarily assume all known and unknown risks associated with treatment, and, to the fullest extent permitted by law, release and hold harmless BODY BY YASHI LLC, its owners, employees, agents, and independent contractors from claims arising out of or relating to the services provided, except where prohibited by law or resulting from gross negligence or willful misconduct. By signing below, I acknowledge that I have read and fully understand this consent, that I am at least 18 years of age or otherwise legally authorized to consent to treatment, and that I voluntarily consent to receive IV therapy from BODY BY YASHI LLC.
*
I agree
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To help us serve you better, please list any additional information.
I understand that all treatments and procedures are subject to medical evaluation. If a treatment or procedure is determined to be inappropriate, cannot be performed, or is discontinued after evaluation, a $100 evaluation fee will apply.
*
I agree
Packages must be used within 6 months of date of purchase. ALL SALES ARE FINAL: There are no refunds or exchanges on any products or services.
*
I agree
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