LightStim Waiver
Low Level Light Therapy/ Red Light Therapy
By signing this waiver form, I acknowledge and confirm the following:
*
I have read the precautions for use of the LightStim Pro Panel, and I affirm that I do not have any conditions listed or any other issues that may cause a reaction from use of this product.
I agree that I use this service at my own risk and will not hold MindSpa901, LLC liable for any adverse reactions.
Client's Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Client's Signature
*
Date Signed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Print Form
Submit
Should be Empty: