Lymphatic Drainage Consent Form | I Am Beautiful by Mia

A few things to prepare, especially post-op:

If this is post-surgical, confirm timing and clearance with your surgeon first.
Hydrate well before your session and wear comfortable clothing.
Have a light meal beforehand.

After your session:

Keep hydrating — a temporary increase in bathroom trips is normal as fluid clears.
If you’re post-op, wear your compression garment as directed by your surgeon.
Avoid heavy meals and alcohol right after; rest and let your body recover.
Results build with a series, especially during post-procedure recovery.

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Section A — Client Information

First Name *

Last Name *

Phone *

Email *

Date of Birth *

Today's Date *

City

State

Postal Code

Emergency Contact Name

Emergency Contact Phone

I agree to receive booking confirmations and appointment reminders at my email address above. *

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Section B — Photo Release

I consent to before/after photos being taken for use on social media and website.

Name preference for photos

Use my name No name Fictitious name

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Section C — Medical History

List any known allergies

List all current medications

Client preferences for next visit

Additional notes for next session

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Section D — Lymphatic Drainage Contraindications

Please check any conditions that apply to you. If any box is checked, your technician will review before proceeding.

Active cancer or currently undergoing cancer treatment Current infection, fever, or acute inflammation Blood clots (DVT) or history of deep vein thrombosis Congestive heart failure Kidney disease or renal failure Currently pregnant (first trimester) Open wounds or recent surgery in treatment area Phlebitis or severe varicose veins in treatment area Uncontrolled hypertension (high blood pressure)

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Section E — Client Consent & Signature

Appointment reminders: I consent to receive appointment reminder messages via SMS. Reply STOP to opt out. Promotions: I consent to receive promotional and marketing messages from I Am Beautiful by Mia. Reply STOP to opt out.

By checking the SMS boxes above, you agree that I Am Beautiful by Mia may contact you at the number provided. This is not a condition of service.

Lymphatic Drainage Massage Consent Form

Before Your Appointment

Aftercare

Section A — Client Information

Section B — Photo Release

Section C — Medical History

Section D — Lymphatic Drainage Contraindications

Section E — Client Consent & Signature