Arm Contouring ProgramAbdominal Fat Reduction ProgramFlank Contouring ProgramUpper Back (Bra Bulge) Reduction ProgramLove Handle Reduction ProgramThigh Slimming ProgramKnee Area Fat Reduction ProgramCalf Contouring ProgramBanana Roll (Under Buttocks) Treatment ProgramDouble Chin Reduction ProgramMorpheus 8 ProgramUltraformer III Body ProgramBody Fx ProgramForma Plus ProgramTiten Fx Program

I consent to and authorize BSL Clinic, its affiliates, agents, representatives, and all persons or entities acting with its permission or upon its authority (collectively "BSL Clinic") to use my photographs and digital images (the "Material") being taken to evaluate treatment effectiveness, for medical education, training, professional publications or sales purposes. No photographs or digital images revealing my identity will be used without my written consent. If my identity is not shown, these photographs and digital images may be used, shared, and displayed publicly without my permission. I further grant BSL Clinic the right to incorporate and use the Material in the video and print ads. Still, photographs, catalogs, packaging, package inserts, website, and all other media (the "Advertising") are used to reproduce, exhibit, broadcast, transmit and distribute Advertising containing the Material. I, at this moment, assign to BSL Clinic all of my rights, title, and interest in and to the Material and any rights, including copyrights that may result from the use of any Material in any Advertising. I waive any right to inspect or approve the Advertising incorporating the Material and the services to which it may be applied. I HAVE READ THE PRECEDING RELEASE AND FULLY UNDERSTAND IT, AND AGREE TO THE TERMS OUTLINED. By checking this box, I agree to the terms of this consent statement.

I agree to the terms of this consent statement.

Attached is a photo of the area that wants the evaluation treatment.
Please upload 1. Before Photo(s) - highest resolution possible

(10 mb)
(10 mb)
(5 mb)