PLEASE NOTE: All information provided above will be held in strict confidentiality. All information is used by service providers to ensure quality and safety of clients.

2338 Major Mackenzie Drive, Unit 2, Vaughan, Ontario, L6A4Y7

www.benefacial.ca

hereby acknowledge and understand that I am receiving medical aesthetic treatment(s) I booked at BeneFacial. I hereby give my free, voluntary and informed consent to receive such treatment(s) I understand that there is one-on-one personal contact involved with these treatments and I am not aware of any medical reasons that would preclude me from requesting or undergoing these treatments.

Furthermore, I hereby agree to defend, indemnify and save harmless BeneFacial and orits principals, employees, or agents from any claims which might arise in relation to any allergic reaction and or other potential liability which might arise from or in the context of the treatments received from BeneFacial. I accept any such liability as a voluntary assumption of risk, and acknowledge that this is a condition precedent to receiving the above treatments. BeneFacial has provided me with a reasonable opportunity to seek independent legal advice prior to signing and accepting these terms and conditions, and has encouraged me to seek such advice, or having been afforded such opportunity, I have elected not to seek such advice.

I consent to photographs being taken to evaluate treatment effectiveness. No photographs revealing my identity will be used without my written consent. I consent to email, text and phone communications related to post-procedure care and follow-up appointments. I consent to receive promotional, appointment, and marketing messages via email, phone and sms from BeneFacial. Before and after treatment protocol have been discussed with me during consultation. The procedure as well as potential benefits and risks have been explained to my satisfaction. I have had all my questions answered.

I am aware that BeneFacial requires a 24-hour cancellation notice or service appointment fee will be charged. Please note that all guests are considered late 15 minutes after the appointment time. It may be necessary to reschedule your appointment.

Any treatment packages that have been purchased are subject to a "No Refund" policy, however packages may be transferred to family and friends. I freely consent to the proposed treatment.

I freely consent to the proposed treatment.