DISCLAIMER
At Lisa Zachary Aesthetics, we strive to provide the highest quality corrective skincare treatments to help address and improve various skin concerns, including acne. However, it is important to understand that individual results may vary and cannot be guaranteed. All treatments and products recommended are based on standard protocols and are tailored to each client's specific skin condition. While we aim to achieve the best possible outcomes, factors such as individual skin type, lifestyle, and adherence to recommended skincare routines can influence the effectiveness of treatments.
By receiving services at Lisa Zachary Aesthetics, you acknowledge and accept that:
Results May Vary: There is no guarantee that the treatments will achieve the desired results. Each person's skin responds differently to treatments and products.
Client Responsibility: Following aftercare instructions and maintaining a consistent skincare routine as advised by our professionals is crucial for optimal results. Lisa Zachary Aesthetics and its staff are not liable for any adverse reactions or less-than-expected outcomes that may occur. Clients should disclose any medical conditions, allergies, or concerns prior to receiving treatments.By proceeding with our services, you agree to this disclaimer and understand the potential risks and variability of results.
Rescheduling: Clients are required to provide at least 48hours' notice for appointment rescheduling to avoid the missed appointment fee. Appointments or cancellations made less than 48 hours in advance will result in a $100 fee charged to the card on file. By signing this form, you authorize Lisa Zachary Aesthetics to charge your card accordingly.
Return or Exchange on Products:
We do not offer refunds or exchanges on any products or services. Once it leaves our clinic it cannot be returned. If you have a defective product or damaged product from shipping please bring it to our office so we may exchange it with the company. Or if you are virtual, please email esthetics@lisazachary.com with photos or videos of the damaged merchandise.
Treatment Package Policy:
Treatment Packages such as facial packages, peel packages, microneedling packages, etc. are not refundable once purchased. Credits may be used towards any other services offered at Lisa Zachary Aesthetics.
Late Arrivals: Clients who arrive more than 15 minutes late may be required to reschedule their appointment, and the missed appointment fee may apply.
Virtual Consultations: Virtual consultation appointments must be confirmed at least 48 hours in advance. Failure to confirm may result in cancellation of the appointment.
Consent for Use of Photos/Videos:
I give Lisa Zachary Aesthetics permission to use my before-and-after images, video footage, and results-based transformation photos for promotional and educational purposes. This includes use on the company’s website, social media, digital advertising, and other public-facing marketing content. I understand that even if identifying details (e.g. my eyes, name, voice) are removed or blurred, the results themselves may still be recognizable to others.
I understand that content shared publicly may be viewed, saved, or reposted by other entities, such as blogs or media platforms, and I will not hold Lisa Zachary Aesthetics responsible for third-party distribution or reposts. I understand that once I give consent for my images or videos to be used, that permission cannot be revoked after content has been published or shared. I acknowledge that Lisa Zachary Aesthetics may use this content for promotional and educational purposes, and I waive the right to request removal once posted.
Treatment Agreement:
With this signature below, I give consent to receive treatments to my service provider and have read and completed this questionnaire truthfully, I understand I will receiving a professional service from a licensed service provider. I further understand that the service provider neither diagnosis illness, disease, or any other medical, physical, or mental disorder. I am responsible for consulting a qualified physician for any ailment that I have. Because the service provider must be aware of any existing medical or physical conditions I may have, I have listed all my known medical conditions and physical limitations and I will inform the specialist in writing of any changes in my physical health. I agree that this constitutes full disclosure. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. If any information changes between my appointments, I will let my service provider know. I understand that there shall be no liability on the service provider for any services rendered.
Arbitration Agreement:
Any dispute, controversy, or claim arising out of or relating to this agreement, including its formation, interpretation, breach, or termination, shall be settled by arbitration administered by the American Arbitration Association under its Commercial Arbitration Rules. The arbitration shall take place in Mt. Laurel, New Jersey, and the laws of New Jersey shall govern the arbitration proceedings. The decision of the arbitrator(s) shall be final and binding, and judgment upon the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof.
Arbitration Agreement:
Article 1: Agreement to Arbitrate: It is understood that any dispute as to medical malpractice, that is as to whether any medical services rendered under this contract were unnecessary or unauthorized or were improperly, negligently or incompetently rendered, will be determined by submission to arbitration as provided by state and federal law, and not by a lawsuit or resort to court process, except as state and federal law provides for judicial review of arbitration proceedings. Both parties to this contract, by entering into it, are giving up their constitutional right to have any such dispute decided in a court of law before a jury, and instead are accepting the use of arbitration. Further, the parties will not have the right to participate as a member of any class of claimants, and there shall be no authority for any dispute to be decided on a class action basis. An arbitration can only decide a dispute between the parties and may not consolidate or join the claims of other persons who have similar claims.
Article 2: All Claims Must be Arbitrated: It is also understood that any dispute that does not relate to medical malpractice, including disputes as to whether or not a dispute is subject to arbitration, as to whether this agreement is unconscionable, and any procedural disputes, will also be determined by submission to binding arbitration. It is the intention of the parties that this agreement bind all parties as to all claims, including claims arising out of or relating to treatment or services provided by the healthcare provider, including any heirs or past, present or future spouse(s) of the patient in relation to all claims, including loss of consortium. This agreement is also intended to bind any children of the patient whether born or unborn at the time of the occurrence giving rise to any claim. This agreement is intended to bind the patient and the healthcare provider and/or other licensed healthcare providers, preceptors, or interns who now or in the future treat the patient while employed by, working or associated with or serving as a back-up for the healthcare provider, including those working at the healthcare provider’s clinic or office or any other clinic or office whether signatories to this form or not.
All claims for monetary damages exceeding the jurisdictional limit of the small claims court against the healthcare provider, and/or the healthcare provider’s associates, association, corporation, partnership, employees, agents and estate, must be arbitrated including, without limitation, claims for loss of consortium, wrongful death, emotional distress, injunctive relief, or punitive damages. This agreement is intended to create an open book account unless and until revoked. Article 3: Procedures and Applicable Law: A demand for arbitration must be communicated in writing to all parties. Each party shall select an arbitrator (party arbitrator) and provide National Arbitration and Mediation (“NAM”) with the party arbitrator’s contact information within thirty days of the date Respondent files its initial responsive pleading. A third arbitrator (neutral arbitrator) shall be selected by the arbitrators appointed by the parties from a list of arbitrators supplied by National Arbitration and Mediation (“NAM”) within thirty days thereafter. The list supplied by NAM shall be a list of between 5 and 10 arbitrators, depending upon availability.
The neutral arbitrator shall then be the sole arbitrator and shall decide the arbitration. Each party to the arbitration shall pay such party’s equal share of the expenses and fees of the neutral arbitrator, together with other expenses of the arbitration incurred or approved by the neutral arbitrator, not including counsel fees, witness fees, or other expenses incurred by a party for such party’s own benefit. Either party shall have the absolute right to bifurcate the issues of liability and damages upon written request to the neutral arbitrator. The parties consent to the intervention and joinder in this arbitration of any person or entity that would otherwise be a proper additional party in a court action, and upon such intervention and joinder, any existing court action against such additional person or entity shall be stayed pending arbitration. The parties agree that provisions of state and federal law, where applicable, establishing the right to introduce evidence of any amount payable as a benefit to the patient to the maximum extent permitted by law, limiting the right to recover non-economic losses, and the right to have a judgment for future damages conformed to periodic payments, shall apply to disputes within this Arbitration Agreement.
The parties further agree that, where not in conflict with this agreement, the Healthcare Malpractice Dispute Resolution Rules and Procedures of NAM shall govern any arbitration conducted pursuant to this Arbitration Agreement. A copy of NAM rules are available on its website at https://www.namadr.com or by calling 1-800-358-2550 to request a copy of the rules.
Article 4: General Provision: All claims based upon the same incident, transaction, or related
circumstances shall be arbitrated in one proceeding. A claim shall be waived and forever barred if (1) on the date notice thereof is received, the claim, if asserted in a civil action, would be barred by the applicable legal statute of limitations, or (2) the claimant fails to pursue the arbitration claim in accordance with the procedures prescribed herein with reasonable diligence.
Article 5: Revocation: This agreement may be revoked by written notice delivered to the healthcare provider within 30 days of signature and, if not revoked, will govern all professional services received by the patient and all other disputes between the parties.
Article 6: Retroactive Effect: If patient intends this agreement to cover services rendered before the date it is signed (for example, emergency treatment), Effective as of the date of first professional services. If any provision of this Arbitration Agreement is held invalid or unenforceable, the remaining provisions
shall remain in full force and shall not be affected by the invalidity of any other provision. I understand thatI have the right to receive a copy of this Arbitration Agreement. By my signature below, I acknowledge that I have received a copy.
NOTICE: BY SIGNING THIS CONTRACT YOU ARE AGREEING TO HAVE ANY ISSUE OF MEDICAL MALPRACTICE DECIDED BY NEUTRAL ARBITRATION AND YOU ARE GIVING UP YOUR RIGHT TOA JURY OR COURT TRIAL. SEE ARTICLE 1 OF THIS CONTRACT.
Both parties agree that this agreement maybe electronically signed, and that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.
Client Signature:
By signing below, I acknowledge that I have read and understand the appointment policy, consent for use of photos/videos, and arbitration agreement outlined above. I agree to abide by these policies and consent to the terms and conditions set forth herein.
Thank you for choosing Lisa Zachary Aesthetics. We are committed to supporting you on your skincare journey with professionalism and care.