Cryoskin Assumption of Risk, Waiver, and Release

  • Cryoskin Assumption of Risk, Waiver, and Release

    For Bella Lash & Beauty Bar

  • By engaging Bella Lash & Beauty Bar (“Company”) to perform the Cryoskin treatments (“Services“), I hereby acknowledge on behalf of myself, my heirs, personal representatives and/or assigns, that there are certain inherent risks and dangers associated with receiving the Service. 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 staff, I would be at physical risk in receiving the treatment, I understand and agree that I may be denied the treatment 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, its 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, (d) no warranty or guarantee, or other assurance, has been made to me covering the results of the Services, (e) knowing the risks involved I nevertheless chose to voluntarily request the Services. 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.

  • Cryoskin should not be used on or applied to clients who have certain medical conditions and/or contraindications as listed below:

  • Contradictions for all Services (CryoSlimming, CryoToning Body, CryoToning Facial, and Electrical Muscle Stimulation (E-Stim))

  • Do you have a progressive disease (MS, ALS, Parkison’s, Neuropathy)?*
  • Recent surgery to treatment area (within last 6 months)?*
  • Do you suffer from Cold allergy or illnesses like: Raynaud's, Cryoglobulinemia, Paroxysmal Cold Hemoglobinuria, Cold Agglutinin Disease?*
  • Do you have wound healing disorder?*
  • Do you have active/severe Eczema, rashes, or dermatitis?*
  • Do you currently have any open or infected wounds?*
  • Do you have a pacemaker or metal implants in or adjacent to desired treatment area?*
  • Do you have silicone or other implants in treated area?*
  • Do you have irremovable body piercings in the desired treatment area?*
  • Do you have Cardiovascular Disease or Lower Limb Ischemia?*
  • Do you have bacterial and viral infections of the skin?*
  • Do you have circulatory disorders?*
  • Do you use of topical antibiotics in desired treatment area?*
  • Do you have impaired skin sensation (desensitization)?*
  • Do you have known sensitivity or allergy to propylene glycol?*

  • Additional contradictions for CryoSlimming, CryoToning Body, Electrical Muscle Stimulation (E-Stim)

  • Are you pregnant, lactating or undergoing IVF?*
  • Do you have any mesh inserts?*

  • Additional contradictions for CryoSlimming

  • Do you have cancer or undergoing cancer treatment?*
  • Do you have HIV/AIDS?*
  • Do you suffer from severe kidney or liver disease?*
  • Do you have any lymphatic drainage disorders?*
  • Do you suffer from uncontrolled diabetes or diabetes related complications?*
  • Do you have incision scar(s) in the desired treatment area?*
  • Do you have hernia in or adjacent to desired treatment area?*

  • Additional contradictions for CryoToning Facial

  • Have you had Botox in the past 30 days?*
  • Have you had fillers or injections in the past 90 days?*

  • Additional contradictions for Electrical Muscle Stimulation (E-Stim)

  • Do you have current or recent bleeding/hemorrhage?*
  • Do you have a compromised circulation?*
  • Do you have regenerating nerves?*
  • Do you have impaired mental status?*
  • Do you have over malignant tissue?*

  • Please read the following statements, accept, and sign below to indicate that you have read the statement and understand it:

  • Format: (000) 000-0000.
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