understand and acknowledge that I am of the full age of 18 years or older. If below 18 years of age a parent or guardian must also sign this form. I confirm that I am not under the influence of alcohol or any illicit or prescription drugs which would in any way impair my ability to agree to the terms of this agreeement or safely commence the procedures herein. This agreement will remain in effect for this procedure and all future procedures conducted by my technicianor any other technician conducting business at The Beauty Box Body Shaper System Inc. I understand that this agreement is binding and that I have read and fully understand all information above.

 

1. RISKS

I fully understand and accept the procedure and risks associated with the procedure/ system I further hereby save harmless and indemnify The Beauty Box Body Shaper System Inc. for any damages whatsoever resulting from me not complying with the request The Beauty Box Body Shaper System Inc.

If at any time I am uncomfortable with the procedure/ system I will inform the esthetician  and the esthetician  will gladly rectify the problem, including ending the session if I (or the esthetician ) wish. It has been represented to me that no guarantees, warranties, promises, commitments or other statement as to the results of this service have been made, and I acknowledge that I have received no particular representation or guarantees, and I am consenting to the procedure at my own risk. 

I have revealed or disclosed conditions and circumstances regarding my health and health history, medication being taken and any past reactions to products used or medication taken. I understand, additional conditions could occur to be discovered during or after the procedure, which could affect my ability to tolerate the procedure. I confirm that I do not have any medical, skin or hair conditions that may interfere with the procedure, application mentioned herein.  

I confirm I do not have any of the following skin conditions. If I have any of the following skin conditions, I understand I will not be suitable for the procedure.

• Sunburn 

• Ultra-Sensitive Skin 

I confirm, I am not pregnant or are breastfeeding. 

 I understand and accept that some mild but normal symptoms may occur depending on the sensitivity of my skin during the procedure and will subside within 24 hours. These symptoms include:

(a) Mild tingling 

(b) Slight redness

(c) Slightly warm in the area 

I acknowledge that I have been advised by The Beauty Box Body Shaper System Inc. of the following potential health/medical risks associated with receiving radio frequency and aparatology and still wish to proceed with the procedures mentioned herein:

(a) Allergic reaction symptoms: itching, severe burning.

I understand individual responses to product used for the procedure  may vary - should a reaction occur, it is my responsibility to seek medical attention at my own expense. 

I will advise the expert/ esthetician of any discomfort, irritation, and/or discomfort immediately. 

I understand it is my responsibility to follow the aftercare instructions for best results.

 

2. WAIVER, RELEASE OF LIABILITY AND INDEMNITY

 

I, inconsideration of The Beauty Box Body Shaper System Inc. completing the procedure(s) mentioned below, hereby release and further agree not to make any claim or demand, or commence legal action against The Beauty Box Body Shaper System Inc. for damages, compensation, loss or any relief whatsoever in respect of any cause or matter relating to the procedure(s). I further agree that this Agreement shall operate conclusively as an estoppel in the event any such claim, action or proceeding and may be pleaded accordingly.

I further agree to hold The Beauty Box Body Shaper System Inc. nameless and harmless from any and all damages. I release The Beauty Box Body Shaper System Inc. from any responsibility for pre-existing conditions I have not revealed, or any consequential change to those conditions that arises after the procedure. I understand I am responsible for any medical treatment I may need to receive because of getting this procedure. I accept full responsibility for these and any other complications, which may arise or resulting of getting this procedure(s), which are to be performed at my request.

Having read the above, I acknowledge that all of procedures contemplated and consented to herein have been fully explained and I fully understand the nature, scope and potential risks of the procedure(s) I am consenting to being performed and accept full responsibility for any and all results of the said procedure.

 

3. PRIVACY

I further acknowledge that any information provided by me to The Beauty Box Body Shaper System Inc. is being provided solely for the purpose of The Beauty Box Body Shaper System Inc. internal records and under no circumstances is it deemed to be given to The Beauty Box Body Shaper System Inc. for the purpose fo making or giving any medical advice, decisions, opinions, diagnosis, or representation to me or any other  third party.

 

 

• I understand that taking the treatment course is my choice and
time, without giving any reason.
• I was told about the possible side effects of the treatment including: skin redness (erythema) and warmth.
• Although these effects are rare and expected to be temporary, any adverse reaction should be reported
immediately.
• I understand that not everyone is a candidate for this treatment and results may vary.
• Iconfirm that I have read and understood the above information and will undergo the treatment out of my own free will.
• I certify that I have been fully informed of the nature and purpose of the procedure, expected outcomes and possible complications and I understand that no guarantee can be given as to the final result obtained. I am fully aware that my condition is of a cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so.

• I believe I have adequate knowledge upon which to base an informed consent.
_____

FINANCIAL: I understand that all payments are due at time of service. To receive package prices, payment must be made for the entire package prior to service.

Services received can NOT be refunded:

No refunds are given for gift card orders / promotions and gift card orders/ promotions are not Exchangeable.

For reimbursement of services/systems, our anti-cellulite program is the only reimbursed for reasons of illness with a justified letter once you notify our staff of the reason for it and the decision is subject to the power of our manager

 

 CANCELLATION/Rescheduling Policy: Please be aware that all cancellations require a minimum of 24hrs notice. Failure to do so will result in that treatment being deducted from your system without a refund. It is important to be aware that this may have a negative effect on your overall results. Any changes to the initial treatment dates will be subject to availability.

• I understand that it is my personal responsibility to inform the clinician of any changes to my medical history during the course of Radio Frequency treatment sessions and I confirm that should this occur I shall advise the clinician of any changes I certify that I have been given the opportunity to ask questions and that I have read and fully understand the contents of this consent form.

____ I authorize before, during and after the procedure(s) the taking of photographs to be part of my patient
profile.

I confirm that all information provided above is correct to the best of my knowledge.

I hereby consent The Beauty Box Body Shaper System Inc. taking photographs of me both before and after the procedures being undertaken by The Beauty Box Body Shaper System Inc. and at the request of myself. It is further understood, acknowledged and herein authorized for The Beauty Box Body Shaper System Inc. to use photographs for the purpose of compiling an album of its various current/past clients to show prospective clients, including but not limited to uploads to social media platforms such as Facebook and Instagram and to be included in The Beauty Box Body Shaper System Inc. course material, the procedures completed by .. in its normal course of business. In the event that I do not wish for The Beauty Box Body Shaper System Inc. to use said photographs in its prospective client photo album or on social media then I shall expressly state so by completing "Schedule A" attached to this Agreement and I thereafter acknowledge and consent to The Beauty Box Body Shaper System Inc. retaining said photographs solely for its own files and internal use in development and monitoring of all services provided. 

I hereby warrant that I have read this Agreement carefully, understand its terms and conditions, acknowledge that I will be waiving certain legal rights by signing it (including the rights of the minor, my spouce, chidlren, parents, guardians, heirs, and next of kin, and any legal personal representatives, executors, administrators, successors, and assigns), acknowledge that I have signed this Agreement freely and voluntarily, without any inducement, assurance or guarantee, and intend for my signature to serve as confirmation of my complete and unconditional acceptance of the terms, conditions and provisions of this Agreement. This Agreement shall be deemed to have been made in accordance with the laws of the Florida. If any provision shall be deemed severable from this Agreement and shall not affect the validity and enforceability of any remaining provisions.

IN WITNESS WHEREOF  the parties hereto acknowledge and agree that they have read and understand the terms of this Agreement on

 

Per (Company Name) : The Beauty Box Body Shaper System Inc.

Esthetician : Emmy Branger

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by
the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

The Beauty Box Body Shaper System Inc. has put in place preventative measures to reduce the spread of COVID-19; however,The Beauty Box Body Shaper System Inc. cannot guarantee that you or those who you will come in contact with will not become infected with COVID-19. Further,proceeding with your appointment and intended service could increase your risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19
and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by proceeding with recieving services from The Beauty Box Body Shaper System Inc. and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at The Beauty Box Body Shaper System Inc. may result from the actions, omissions, or negligence of myself and others, including, but not limited to,The Beauty Box Body Shaper System Inc. employees and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my use of services with The Beauty Box Body Shaper System Inc. (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless The Beauty Box Body Shaper System  Inc, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of The Beauty Box Body Shaper System Inc., its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after receiving any services from The Beauty Box Body Shaper System Inc..