Please only fill this form out IN OFFICE at your first appointment. 

Name *
Phone *
Address *
Date *
Checkbox *
If you do not follow the instructions for your sessions, you will not see BEST results. For best results, please come 3 days per week with one day in between sessions. Best results are with 10-14 Sessions. Most will start seeing results within 3 sessions but need more then just 3 sessions for long term results. We recommend drinking one bottled water before and one bottled water after your sessions. All sessions are 30 minutes long. This includes time to change clothes. If you are more then five minutes late to your session, you will have to reschedule. YOU MAY ONLY USE THIS MACHINE ONCE EVERY 24 HOURS PER STATE LAW. WE MAKE NO CLAIMS THAT THIS MACHINE CURES ANY DISEASE. ALL PAYMENTS ARE ONLY EXCEPTED ON THIS WEBSITE PLEASE REPORT ANY OTHER FORMS OF PAYMENT TO INFO@THESCULPTPOD.COM. NEVER USE THE SCULPT POD IF YOU ARE PREGNANT OR HAVE A HEART CONDITION. Use caution with persons sensitive to light and heat. ALL jewelry must be removed. NO METAL IMPLANTS OR UNDERWIRE. Titanium implants are approved. We suggest women to wear a sports bra and panties, Men just underwear. CONTRADICTIONS: EPILESPY, ACTIVE CANCER, BROKEN BONES, INTOXICATION, INFECTIOUS OR CONTAGIOUS SKIN CONDITIONS, ERYTHEMA, PACEMAKERS AND DEFIBRILLATORS. You must have a doctors consent before using the pod if you have diabetes, using medication such as diuretics, barbiturates or beta blockers, hemophiliacs or individuals with sensitive skin or poor blood circulation. This machine WILL FADE tattoos. PLEASE DO NOT EAT ONE HOUR BEFORE OR ONE HOUR AFTER YOUR SESSION. PLEASE DRINK ONE BOTTLED WATER AFTER YOUR SESSION TO FLUSH FAT AND TOXINS OUT. Any and all Coupons -GROUPONS -Facebook Offers- Living Social ect. CAN ONLY BE PURCHASED AND USED ONCE EVERY 60 DAYS. IF I SUBMIT TO HAVING A BEFORE AND AFTER PICTURE TAKEN, I AM FULLY AWARE AND AGREE THAT IT CAN BE USED ON OUR WEBSITE AND SOCIAL MEDIA PLATFORMS. YOUR FACE, NAME AND INFORMATION WILL NOT BE USED. ON BEHALF OF SCULPT POD, INC WE DO NOT ALLOW ANY REFUNDS OR TRANSFERRING SESSIONS BETWEEN CUSTOMERS. Get Ready To Get Fit! Thank you for your business!