T-Shape 2 Waiver

ASSUMPTION OF RISK, WAIVER, AND RELEASE

By engaging Beauté Aesthetics (hereinafter referred to as the “Company”) to provide T-Shape 2 sessions and related services (hereinafter referred to as the “Services”) and using the Company’s equipment and facilities in relation thereto, I   First Name*   Last Name*   (hereinafter referred to as “I”, “you”, “myself”, and “me”) hereby acknowledge on behalf of myself, my heirs, personal representatives and/or assigns, that there are certain inherent risks and dangers associated with receiving Services and my use of the Company’s equipment and facilities. At all times, I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions given to me by staff. If in the subjective opinion of the Company’s staff, I would be at physical risk in receiving Services, I understand and agree that I may be denied access to Services until I furnish the Company with an opinion letter from my medical doctor, at my sole cost and expense, specifically addressing the Company’s concerns and stating that the Company’s concerns are unfounded.

I hereby: (1) agree to assume full responsibility for any and all injuries or damage which are sustained or aggravated by me in relation to my receiving of the Services; (2) release, indemnify, and hold harmless the Company and the distributor and manufacturer of any equipment, device, or product used during the Services, their respective direct and indirect parent, subsidiary affiliate entities, and each of their respective officers, directors, members, employees, representatives and agents, and each of their respective successors and assigns and all others, from any and all responsibility, claims, actions, suits, procedures, costs, expenses, damages, and liabilities to the fullest extent allowed by law arising out of or in any way related to the Services; and (3) represent that: (a) I have no medical or physical condition that would prevent me from receiving the Services, (b) I do not have a physical or mental condition that would put me in any physical or medical danger, (c) I have not been instructed by a physician to not receive Services or similar services, (d) no warranty or guarantee, or other assurance, has been relied upon or made to me concerning the results of the Services or the Service’s effects and side-effects, (e) knowing the risks involved, I nevertheless chose to voluntarily request the Services, (f) I am not currently under or suffering from the effects of any prescribed medication, illicit drugs, or alcohol and further representhat that I am of sounds mind and make all representations freely and voluntarily, and (g) the Services provided do no constitute medical or health carte services and that employees and associates of the Company are not health care practitioners and cannot diagnose and/or treat individual health problems.. Notwithstanding the foregoing (and by way of illustration only and not limitation) if any of the following apply to me or if I’m unsure for any reason, I hereby acknowledge the Company’s recommendation that I consult a medical physician before receiving Services.

In participating in the Services, I understand that I may be photographed, videoed, or otherwise recorded by the Company for safety, monitoring, training, and marketing purposes. I hereby consent to such usage of imagery, video, or other media for all and any such purpose by the Company and hereby agree that the Company without any payment to you shall in all cases be the sole owner of all intellectual and other proprietary rights therein without any restriction whatsoever.

I HAVE READ THIS ASSUMPTION OF RISK, WAIVER, AND RELEASE, FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS, INCLUDING MY RIGHT TO SUE THE COMPANY UNDER CERTAIN CIRCUMSTANCES. I ACKNOWLEDGE THAT I AM SIGNING THIS WAIVER FREELY AND VOLUNTARILY. THE TERM OF THIS WAIVER IS INDEFINITE.

Emergency Contact Name:   First Name*   Last Name*   
Phone:   Area Code*   Phone Number*   

Client:
Print Name:   First Name*   Last Name*   
Signature:   Signature*   
Date:   Date*   

RISKS, LIMITATIONS, AND CONTRAINDICATIONS FOR T-SHAPE 2
T-Shape 2 Sessions:
NOTE: This document may contain general information relating to various medical conditions and contraindications, some of which are based upon recommendations from the manufacturer. Such information is provided for informational purposes only and is not meant to be a substitute for advice provided by a doctor or other qualified healthcare professionals. If you have questions about your overall health or whether you have any of the conditions listed below, you should consult your doctor or other qualified healthcare professional.

● Pregnancy/lactating 
● Metal implants 
● Active Implanted devices (pacemaker, urethral stimulator or internal defibrillator) 
● Cardiovascular disorders 
● Varicose veins in desired treatment area
● Thrombophlebitis 
● Active Cancer or Cancer treatments in the past five years (unless doctor’s clearance is received)
● Current Outbreak of Hives 
● Active Herpes 
● Glandular swelling 
● Sensitivity to light or consuming photosensitive medications
● Vitiligo
● Lupus
● Accutane
● Skin diseases or abnormal wound healing 
● Surgery in the treatment area in the last three months
● Fillers received within the last 4 weeks in the desired treatment area
● Botox within the past two weeks in the desired treatment area
● Open lesions
● Implant contraceptive
● Subcutaneous Hormone Pellets (HRT)
● PDO Threads

Consult Physician
○ Autoimmune Diseases
○ Hypotension & Hypertension
○ Dilated capillaries
○ Liver/Kidney Disorders
○ Poorly Controlled Diabetes Type 1 & 2
○ Hereditary anaphylaxis
○ Keloid scar formation
○ Oral/ Topical Acne Medications
○ Anticoagulant Therapy

I have read and acknowledged the risks, limitations, and contraindications of T-Shape 2 sessions.