At Celllora MediSpa, we take your safety and well-being seriously. However, it is your responsibility to take precaution and comply with all safety measures, guidelines and protocols stipulated by Celllora MediSpa. Celllora MediSpa is not liable for any harm and/or loss whatsoever unless arising from our negligence or intentional misconduct.
Please take your time to read the following carefully and confirm that you have read and agree to the items by checking the box at the end and signing. If you do not understand any part of the following, kindly seek the assistance of our beautician (Celllobritas) to explain it to you. All Celllora MediSpa clients are required to sign this consent regardless of which procedure they choose to undertake.
- I am a person of full legal and mental capacity, and I have made an independent and voluntary decision to enter this consent with a full understanding of its contents.
For those clients doing the procedure.
- I have been given information on the benefits and risks of the Celllora MediSpa procedure and hereby agree to undertake the consultation and procedure.
- Results: I have been informed that the result or outcome from the procedure differs from person-to-person, and results cannot be guaranteed by Celllora MediSpa.
- Celllora MediSpa has set the recommended duration of procedure per session to ensure maximum safety and minimize risks to all patients. Celllora MediSpa has the right not to treat a client if our Celllobritas deem it unsafe to do so.
- I voluntarily consent to undergo the procedure with the knowledge that complications are rare but possible.
- I also understand that under certain circumstances, petechiae (tiny reddish/ purplish spots caused by broken capillaries) may occur in the areas of procedure and these usually resolve within 1-2 weeks.
- I understand that the procedure carries the risk of triggering existing and previous eczema and agree to undergo the procedure despite this.
- I understand that it is an occasional risk that acne may appear as a result of undergoing the procedure, and will likely to improve with the continued procedure.
- Since it is impossible to state every risk or complication that may occur as a result of any procedure, the possible risks and complications listed in this informed consent may be incomplete.
- I have been given the information on the benefits and risk of the Celllora MediSpa Treatment and hereby agree to undertake the consultation and procedure.
I hereby confirm that:
- I am not pregnant
- I do not have Cold Hives, Paroxysmal Cold Haemoglobinuria and Raynaud's Phenomenon.
- I do not have a cardiac condition (Arrhythmia, Coronary Heart Disease) or pacemaker.
- I do not have a surgical metal implant.
- I do not have dermatitis or an infection in the procedure area.
- I do not have systemic Lupus Erythematosus.
- I do not have Herpes Simplex.
- I have not had Botox or fillers on the procedure area within the last two weeks.
- I have not had facelift threading on the procedure area within the last two weeks.
- I have not had surgery on the procedure area within the last two months.
In extremely rare cases, exposure to cold and vasoconstriction can impact hypertension and induce cardiac complications. Celllora MediSpa takes no responsibility for such complications.
Others:
- Also, I agree to photographs being taken to evaluate procedure effectiveness, for education, training, professional publications and/or promotional purposes (with client consent).
- Procedure Payment: Is paid for in advanced. If you share a procedure package, Celllora MediSpa will take no responsibility for the financial dealings between the people involved in sharing the package. A procedure credit will be deducted when entering the queue in our store. Once these are issued, they are non-refundable.
- Expiry Date: all procedures have an expiry date; after this date, Celllora MediSpa has the right to nullify these procedures.
I understand and further confirm as follows: -
- Celllora MediSpa has the right to refuse service to anyone. In such situations where the client has paid in advance, Celllora MediSpa will refund all unutilized parts of the payment. In all other instances, Celllora MediSpa practices a strict ‘no refund’ policy.
- Celllora MediSpa reserved a right to amend its policies, prices, promotions without prior notice.
- I understand the risk and benefits of this procedure, and I elect to proceed and consent to the procedure.
- I have read and fully understand the terms and conditions set out above.
- I have made full disclosure.
- I hereby authorize Celllora MediSpa to perform the procedure.
- I am at least 18 years of age (minors must be accompanied by parents or guardians who will sign this form on behalf).
- This document is governed by Malaysian law, and each provision is severable. If any provision of this consent becomes invalid under Malaysian law, the remaining provisions shall remain and shall not be affected.
- I have not withheld any information and have made full and true disclosure.
Celllora MediSpa is not responsible for any loss or damage to the client’s personal belongings while in the premises.
By signing below, I accept all the terms and conditions stated in the form.