Terms of Business and Participants Consent
www.fasttrackweightlossprogram.co.uk
12 Week Program Trial
Introduction
The fasttrackweigtlossprogram is an innovative way of losing weight quickly, while targeting the
fatty areas of most need to shorten the time in which you can see results. We believe that
motivation is best achieved through seeing results as soon as possible into any weight loss program.
The program is a combination of 3 elements which work together to accelerate results.
A combination of 3 well known and recognised techniques, which working together accelerate
success. We think in 12 weeks you will really see a difference which will motivate you to carry on
your more healthy lifestyle.
The three elements are:
Very Low Calorie Diet (“VLCD”)
We all accept that to lose weight you must consume fewer calories than you expend. Indeed to lose
a pound you need to have a calorie deficit of 3,500 calories on average. That means to lose 4 pounds
a week you need to consume 14,000 calories less than you expend. This can be achieved through
diet and exercise – but many overweight people find the prospect of exercise daunting.
VCLDs are designed to help maximise this calorie deficit and put the body into a state of ketosis in
which the body burns fat instead of carbohydrates for energy. At any time we can test your urine for
Ketones which evidence the process of Ketosis.
We will measure your BMR (Base Metabolic Rate) which is the number of calories your body is using
in a resting state and from that info estimate your potential weight loss without the use of exercise.
Throughout the program your BMR will change and hence your weight loss might fluctuate due to
this and other factors.
This is the part of the program that needs commitment and resolve. If you are not sure you can
commit to it for 12 weeks, the effects of the other treatments will not be maximised.
The supplier for VCLD we recommend is “Exante – www.exantediet.com” who have an excellent
reputation as providers of VLCDs and are the most cost effective.
Ultrasound Liposuction (www.ultasoundliposuction.co.uk)
This is the non invasive use of ultrasound waves to target the areas of most subcutaneous fat
(eg. stomach, thighs and bottom). By targeting these areas we can accelerate the results of the
program in the areas that you most want.
Fat stores under the skin are relatively resistant to any diet treatment as they generally have a poor
blood supply. The ultrasound treatment releases fat from the fat cells in these resistant into the
surrounding tissue fluid and this is transported away via the lymphatic system. The ultrasound
treatments are therefore necessary for the contouring of your body shape and release an additional
supply of energy for your body whilst on the Program.
Lipo-massage
With any considerable weight loss it is likely that unsightly excess skin will normally arise. In severe
cases this can lead to a need for surgery to attempt to correct the problem.
To minimise these problems, the fasttrackweightlossprogram uses tried and tested lipo-massage
techniques, also known as connective tissue massage. Using equipment supplied by Endermologie
(www.lpgendermologie.co.uk ), we use weekly sessions of skin and connective tissue treatment
which stimulates the skin and connective tissue contraction as your weight is lost.
This treatment has the additional benefit of stimulating lymphatic drainage, helping to remove the
fat released by the ultrasound treatment into the circulation for metabolism.
You will receive weekly treatments straight after your lipo-ultrasound.
On its own this treatment is proven to promote weight and inches loss and when combined with diet
and ultrasound it is extremely effective.
The Process for the 12 Week Program
Induction
Meeting
Week
1
2
3
4
5
6
7
8
9
10
11
12
BMR test &
lifestyle plan
Induction Meeting:
Full Explanation of Program
Explanation of Terms of Business
Review of Health Status
Measurement of weight, height, BMI, BMR, Blood Pressure
Q&A
Photographs
Weekly Meeting:
Measurement of weight, height, BMI, BMR, Blood Pressure
Review of progress
Urine Test
Ultrasound Treatment
Lipo-massage Treatment
Summary of results including photos e-mailed
Monthly:
Purchase of Month supply of Foods via “Exante” delivered direct.
Final Meeting
BMR retest and Plan for maintenance
Trials
Fasttrackweightlossprogram is an innovative 12 week program as explained above. For
those chosen to join our trials we providing free ultrasound and lipo-massage treatments
over a 12 week period (with a total value of £1,200). The Trialist will be responsible for the
purchase of their own foods direct from Exante at a daily cost from £4.00. This will replace
all other expenditure required on food etc during the trial period.
In return for this the Trialist:
1. Will consult with their GP as to their suitability for the program
2. Will commit to the program for a 12 week period. Should the Trialist fail to
complete the trial they will be charged 50% of the treatments given to date (ie £50
per week into the program) unless there are medical or other relevant reasons for
non completion.
3. Allow the use of case study/photographs by fasttrackweightlossprogram for
promotional purposes in perpetuity
4.
For the period of the program undertake to maintain their water intake to at
least 2/3 litres per day
Fasttrackweightlossprogram undertakes:
1.
At all times to act in the interest of the client
2.
It will not commence the program until giving the client time to
consider and refer to their GP on their suitability
3.
Not to continue the treatment without GP consent where the basic
indicators of pulse, blood pressure and Metabolic Rate give rise for
concern
4.
Not to commence treatment where any of the medical conditions
showing as contra-indications have been made known by the client.
5.
Not to continue treatment should it become evident that the Client
is not committed to the completion of the Program
The Client undertakes:
1. To honestly answer all questions asked of them prior to
commencement of the Program
2. To commit to the Program for the 12 weeks and abide by the advice
offered by Fasttrackweightlossprogram
3. Not to drink alcohol during the Program
4. Fot the period of the trial and after completion of the trial, not to
hold fasttrackweightlossprogram responsible for any adverse
outcomes arising from the Program.
Possible Adverse effects to Program
In order to be fully informed you should be made aware of foreseeable adverse effects that could
occur. Adverse effects that could arise from the Program include, but are not limited to:
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Headaches, nausea and rarely vomiting. If this problem occurs it is usually only transient and
limited to the first few days of treatment
Constipation. This risk can be minimised by ensuring you are drinking the prescribed amount
(3 litres per day) of water
Light headedness or dizziness. Due to the lowering of your blood pressure (your blood
pressure will be monitored by us each week and corrective action will be taken if necessary)
Emotional disturbances due to the hormonal changes in the body and the production of
ketone waste products of fat metabolism
Skin irritation or rash due to the use of ultrasound or Endermologie treatment.,
Tinnitus or exacerbation of this condition in those predisposed to it as a result of the use of
ultrasound treatment
Diffuse hair loss due to the changes in the body’s metabolism
Gout due to the amino acid content of the nutrition and reduced renal (kidney) excretions of
uric acid during weight loss.
Gallstones. This potential adverse effect is not specific to the Program, but gallstone and
biliary sludge formation is a general risk of any weight loss treatment such as any prolonged
dieting resulting in significant weight loss and it is a particularly common problem after
surgical treatments sometimes used for the treatment of overweight patients. However, the
risk of gallstones during weight loss must always be taken seriously and to minimise the risk
of problems due to gallstones, it is vital that you do not drink any alcohol for the duration of
the Program..
As with any treatment there is also a possibility of other unknown or unforeseen adverse effects
occurring
You should NOT have treatment and must inform us prior to treatment if:
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You are pregnant or could be pregnant (i.e. if you are late for a menstrual period)
You are breastfeeding
You have any significant present or past health problems as determined your GP
You should not have the ultrasound treatment if you have;
Significant skin disorders or infections, phlebitis, a history of cancer in the previous 2
years, skin grafts, history of joint replacement surgery in the previous 2 years, an
eardrum prosthesis, significant tinnitus, a cardiac pacemaker, severe hypertension
or sever varicose veins
You should not have the skin and connective tissue treatment if you have:
Allergy to the materials from which the body suit is made, significant skin disorders
or infections, significant varicose veins (any areas affected should not be treated)
and care must be taken if you have very thin or delicate skin or are at high risk of
bruising.
You have had any previous significant adverse reaction to this or similar treatment.
You must also fully inform us and take the advice of your GP, prior to
treatment if:
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You are taking any prescription medication
You have any disorder of your immune system or are taking any medication to suppress your
immune system
You have a history of any allergies whatsoever
You have, or have a past history of, any physical or mental health problems of any kind.
You have had any surgery of any kind
You are under the influence of any intoxicating substance
You are uncertain, for any reason, whether you wish to proceed with this treatment
Please read both this information form and the attached ‘Informed Consent & Terms and Conditions
of treatment@ form carefully and sign and date both prior to treatment.
If you have any questions, please ask and do not proceed with treatment unless all of your questions
have been answered to your full satisfaction.
Name ………………………………………………………………….. Date of Birth ………………………………………..
Signature……………………………………………………………….. Date………………………………………………………
Informed Consent and Terms and Conditions of Treatment
Name……………………………………………………………………………… date of Birth…………………………….
Treatment………12 week fasttrackweightlossprogram ……………………………………………………….
I have carefully read and understood the attached information sheets that I have signed concerning
the treatment and I have had the opportunity and sufficient time to ask questions about any content
that I did not understand. All my questions have been answered to my full satisfaction.
In particular, I understand that adverse effects could arise from this treatment, which include, but
are not limited to, those about which I have been specifically informed. I also understand that there
is a possibility of unknown or unforeseen adverse effects arising from his treatment about which I
will therefore not have been specifically informed.
By signing this form, I hereby consent to undertake this treatment at my own risk and I agree to
indemnify both the practitioner and Cornelius House Enterprises Limited (trading as
fasttrackweightlossprogram) in all circumstances against any claim, or damages arising ad a result of
any adverse effect of this treatment, whether foreseen or unforeseen and, hence, regardless of
whether I have been specifically informed about the possibility of such adverse effect or not.
I have been informed of possible alternatives to proceeding with this treatment, including my free
choice of having no treatment at all. I have had sufficient time to make my decision and I have been
put under no pressure whatsoever to proceed with treatment.
Terms and Conditions of treatment
I understand that all treatment is provided on the terms that all fees paid are in respect of provision
of a professional service and not on respect of obtaining any specific result. I understand that the
practitioner will undertake to use his/her skill, knowledge and experience to the best of his/her
ability, on my behalf, to endeavour to achieve a satisfactory result. However, I understand that
variation in response to any treatment does occur from person to person and that no specific result
can be obtained on the case of suboptimal or unsuccessful result ad all fees paid are entirely in
respect of the service provided, i.e. professional time, expertise, product costs and other costs
incurred by the clinic in providing my treatment and such costs are incurred independently of results
achieved.
Problems and Complaints
Should you experience a problem of any kind, we would like to be given the opportunity to solve it.
Please contact our manager Kim Kellas on should the need arise.
I confirm that I have carefully read, understood and agree to all the contents of this document. My
signature also indicates my consent and agreement to a the contents of this document for any
future treatments of a similar nature at this clinic
Clients’ signature………………………………………………………………… Date…………………………………….
Fees Applicable to Your Program
Consultation Fees:
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Initial consultation (60 minutes) Free (Trials – Free)
Final consultation (45 minutes) £50
(Trials – Free)
Including BMR rate test and, personal maintenance plan
Treatment Fees:
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Start Up Costs - One therapy suit, one basal metabolic rate test £50 (Trials Free)
Non recurring purchase of therapy suit for Endermologie treatments (Replace cost £25)
Combined weekly ultrasound liposuction and lipo-massage £100 for 1 hour (Trials Free)
Single Endermologie treatments £75 (if required)
Single ultrasound treatments: £65 (if required)
Food Fees
Food is bought directly by Client from www.exantediet.com who will deliver direct to your
home/office by courier at no extra cost.
For the most cost effective method purchase 4 weekly packs. Foods consist of Shakes, Soups,
Bars, Other Dishes. For further information please refer to website.
Fasttrackweightlossprogram.com is an affiliate of Exantediet.com and as such receives
commission of 10% on your purchases.
A “4 week bumper pack” is currently available at £109 which works out at £3.89 per day.
No other foods are required. Please see website for further info