| 
               AREA OF TREATMENT 
  
  
  • • •
  
 | 
          
            
               PHOTO 
  
  
  
  
 | 
          
          
| 
               Pre Treatment Measurement 
  
  
  
  
 | 
          
            
               PHOTO 
  
  
  
  
 | 
          
          
| 
               WEIGHT/HYDRATION LEVEL 
  
  
  
  
 | 
          
            
               PHOTO 
  
  
  
  
 | 
          
          
| 
               TREATMENT # 
  
  
  • • •
  
 | 
          
            
               PHOTO 
  
  
  
  
 | 
          
          
| 
               HIFEM SETTING 
  
  
  • • •
  
 | 
          
            
               PHOTO 
  
  
  
  
 | 
          
          
| 
               INTENSITY  
  
  
  
  
 | 
          
            
               PHOTO 
  
  
  
  
 | 
          
          
| 
               CONSENT/AFTERCARE SIGNED AND GIVEN 
  
  
  
  
 | 
          
            
               PHOTO 
  
  
  
  
 | 
          
          
| 
               PROVIDER 
  
  
  • • •
  
 | 
          
            
               PHOTO 
  
  
  
  
 | 
          
          
| 
               Comments 
  
  
  
  
 | 
          
            
               PHOTO 
  
  
  
  
 | 
          
          
| 
               EMSCULPT NEO CONSENT p1 
  
  
  
  
 | 
          
            
               PHOTO 
  
  
  
  
 | 
          
          
| 
               EMSCULPT NEO CONSENT p2 
  
  
  
  
 | 
          
            
               | 
          
          
| 
               EMSCULPT NEO CONSENT p3 
  
  
  
  
 | 
          
            
               | 
          
          
| 
               EMSCULPT NEO CONSENT p4 
  
  
  
  
 | 
          
            
               | 
          
          
