Saline Tattoo Removal Waiver Form

SALINE TATTOO REMOVAL WAIVER , RELEASE, ASSUMPTION OF RISK, INDEMNITY AND CONSENT AGREEMENT

WAIVER, RELEASE, ASSUMPTION OF RISK, INDEMNITY AND CONSENT AGREEMENT WARNING: Read carefully. This Agreement includes a Release of Liability and Waiver of legal rights and deprives you of the right to sue Marveleyes Inc., its management and employees and/or contractors. Do not sign this agreement unless you have read it in its entirety.
I understand tattoo removal is a process with many variables, therefore how much pigment is removed during each visit, or how many visits are needed, cannot be known or guaranteedI understand that a patch test can determine within 24 hours if I may have a reaction to Botched Ink® solution, but that it is inconclusive regarding whether I will have an allergic reaction at any time in the future, to the release of tattoo pigment from the skin, or to the product. Therefore, I waiver my option to a patch test and wish to proceed with the treatmentI understand that additional work cannot be undertaken for 8 weeks to allow the skin to fully healMy technician has discussed likely outcomes with me, recommending a treatment plan, prior to any work being agreed and carried outI agree that my technician will use this client file and treatment plan to record my details, and a log of treatments and techniques used. I understand I can request to see this file at any timeI understand that after each treatment the treated area may swell, show redness and, in some cases, bruising. My technician will recommend how to take care of thisI have been given aftercare instructions and I understand that I must adhere strictly to these instructions. I understand my technician cannot give medical advice in the unlikely event of an infection, so I will immediately seek attention from a General Practitioner (GP), Doctor or PharmacistI understand any health condition or medication may affect the treatment including bruising, bleeding, healing and how much pigment removesI understand the importance of providing an accurate and complete medical history and that with holding any medical conditions may be detrimental to my health and the outcome of the procedureI understand that there are no guarantees as to the success of my BotchedInk® saline tattoo removal treatment, I also understand no refunds can be given as a treatment has been carried out
I First Name* Last Name* confirm that I have read, acknowledged, and fully understood the terms of the treatment. I also affirm that the information I have provided is true and accurate to the best of my knowledge and ability.
I, in consideration of Amanda Cheng (the technician) and Marveleyes Inc. completing the procedure(s) described below, hereby release and agree not to make any claim, demand, or legal action against Marveleyes Inc. for any damages, compensation, loss, or relief of any kind related to the procedure(s). This Agreement shall serve as a complete and conclusive defense to any such claims, actions, or proceedings.I further accept full responsibility for, and agree to indemnify and hold Marveleyes Inc., its employees, and/or contractors harmless from any and all liabilities, losses, damages, or claims of any nature whatsoever related to the procedure(s) performed.Having read and understood the above, I acknowledge that all aspects of the procedures contemplated and consented to herein have been fully explained to me. I fully understand the nature, scope, and potential risks of the procedure(s) and accept full responsibility for any and all outcomes resulting from these procedures.
I, further acknowledge and agree that any information provided by me to Marveleyes Inc. is intended solely for Marveleyes Inc.’s internal record-keeping purposes. This information is not to be considered as medical advice, a medical decision, a medical opinion, a diagnosis, or any form of representation to me or any third party. Marveleyes Inc. does not offer medical services or advice, and any information provided by me does not create a doctor-patient relationship or any other professional medical relationship.
I, hereby consent to Marveleyes Inc. and its employees and/or contractors performing the procedure(s) for Botched Ink® Saline Tattoo Removal on me.I warrant that I have read this Agreement carefully, understand its terms and conditions, and acknowledge that by signing it, I am waiving certain legal rights. This includes the rights of myself, my spouse, children, parents, guardians, heirs, next of kin, and any legal personal representatives, executors, administrators, successors, and assigns. I acknowledge that I am signing this Agreement freely and voluntarily, without any inducement, assurance, or guarantee, and that my signature represents my complete and unconditional acceptance of the terms, conditions, and provisions of this Agreement.This Agreement shall be governed by and construed in accordance with the laws of the Province of Alberta. If any provision of this Agreement is found to be invalid or unenforceable, it shall be deemed severable, and the remaining provisions shall continue to be valid and enforceable.
I further consent to Marveleyes Inc. taking photographs of me both before and after the procedure(s) undertaken by Marveleyes Inc., and at my request. I understand, acknowledge, and authorize Marveleyes Inc. to use these photographs for the purpose of creating an album of its current and past clients to showcase to prospective clients. This includes, but is not limited to, posting on social media platforms such as Facebook and Instagram, and including in Marveleyes Inc.’s training course material and promotional materials related to the procedures performed by Marveleyes Inc. in the normal course of its business. I acknowledge and consent to Marveleyes Inc. retaining these photographs solely for its own files and internal use for the development and monitoring of its services.
I First Name* Last Name* confirm I have read through , acknowledge, agree, and understand the complete document and the risks and terms of agreement. I acknowledge and give my informed consent to having this and future Botched Ink® Saline Tattoo Removal procedure in perpetuity.
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Per (Company Name) : Marveleyes Inc.

Artist/Technician Name: Amanda Cheng

SALINE TATTOO REMOVAL WAIVER , RELEASE, ASSUMPTION OF RISK, INDEMNITY AND CONSENT AGREEMENT

Botched Ink Saline Tattoo Removal Health Questionnaire