WAIVER - Mareleyes PMU Brow 2020

- Semi-Permanent Brows (Nano, Combo, or Powder Ombre Brows) - WAIVER, RELEASE, ASSUMPTION OF RISK, INDEMNITY AND CONSENT AGREEMENT

WAIVER, RELEASE, ASSUMPTION OF RISK, INDEMNITY AND CONSENT AGREEMENT WARNING: Read carefully. This Agreement includes a Release of Liability and Waiver of legal rights and deprives you of the right to sue Marveleyes Inc., its management and employees and/or contractors. Do not sign this agreement unless you have read it in its entirety.
I, First Name* Last Name*, understand and acknowledge that I am of the full age of 18 years and 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 Agreement or safely commence the procedures herein.
My technician has provided a thorough consultation and discussed the entire procedure thoroughly.I have been given aftercare instructions and I understand that I must adhere strictly to these instructions. I understand my technician cannot give medical advice in the unlikely event of an infection, so I will immediately seek attention from a General Practitioner (GP), Doctor or PharmacistI agree that my technician will use this client file and treatment plan to record my details, and a log of treatments and techniques used. I understand I can request to see this file at any timeI understand that additional work cannot be undertaken for 4 weeks to allow the skin to fully healI understand Semi-Permanent Brows procedure is a process with many variables, thus it has been represented to me that there are 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 acknowledge that Marveleyes Inc. has advised me that the procedures mentioned herein are not suitable or recommended for individuals who are pregnant and/or breastfeeding.I understand that Marveleyes Inc. has provided this advice for my safety and well-being. By proceeding with the procedures despite this advice, I voluntarily assume all risks associated with undergoing the procedures while pregnant and/or breastfeeding.I agree to indemnify, defend, and hold Marveleyes Inc., including its officers, employees, and contractors, harmless from and against any and all claims, liabilities, damages, losses, or expenses (including reasonable attorneys' fees) arising from or related to my decision to proceed with the procedures under these circumstances.This indemnity extends to any claims, damages, or losses resulting from my failure to comply with Marveleyes Inc.’s recommendation not to undergo the procedures during pregnancy and/or breastfeeding.To the best of my knowledge and belief, I hereby confirm that I do not have hemophilia, nor am I taking any blood thinning medications or other medications, including but not limited to Accutane, which may interfere with the procedure, application, or healing of any procedure referenced herein. Additionally, I confirm that I do not have any other medical or skin conditions that may interfere with the procedure, application, or healing of any procedure referenced herein.I acknowledge that I have been advised by Marveleyes Inc. of the following potential health/medical risks associated with tattooing and still wish to proceed with the procedures mentioned herein: (A) allergic reaction to numbing, pigment, or aftercare (A&D ointment / Cavilon Barrier Cream) including but not limited to: pimples appearing in the treated area, redness, itchiness, pain, raised pigmented areas and rashes;(B) scarring to pigmented areas (for clients with keloid conditions);(C) infection;(D) MRI complications including but not limited to interfering with the quality of the image and potential swelling or burning to the area as a result of interactions between the magnetic fields and the pigment; or (E) Granulomas (small knots or bumps that form around material the body perceives as foreign; such as tattoo pigment)I have informed the technician of any medical conditions, allergies, or medications that could affect the procedure.I understand those with certain medical conditions (e.g., diabetes, active skin disease, keloid scarring), or those undergoing chemotherapy may be advised against undergoing the procedure.I understand that a patch test can determine within 24 hours if I may have a reaction, but that it is inconclusive regarding whether I will have an allergic reaction at any time in the future, to the release of any product used in the procedure. Therefore, I waiver my option to a patch test and wish to proceed with the treatment
In consideration of Amanda Cheng (the technician) and Marveleyes Inc. performing the procedure(s) mentioned below, I hereby release and agree not to make any claim or demand, or commence any legal action against Marveleyes Inc. for damages, compensation, loss, or any other 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 of such claim, action, or proceeding and may be pleaded accordingly.I hereby accept full responsibility for, and agree to indemnify and hold harmless, Marveleyes Inc., and any of its employees and/or contractors, from any and all liability whatsoever regarding the pigment, coloration, and position of all pigment makeup applied to my eyebrows. I also confirm that no neuromdulators or face procedures have been done at least 1 month prior to the commencement of the Semi-permanent brow procedure to which I am consenting.Having read the above, I acknowledge that all aspects of the semi-permanent brow procedures contemplated and consented to herein have been fully explained to me. I fully understand the nature, scope, and potential risks of the procedure(s) to which I am consenting. I accept full responsibility for any and all results of said procedure(s).
I, further acknowledge and agree that any information provided by me to Marveleyes Inc. is intended solely for Marveleyes Inc.’s internal record-keeping purposes. This information is not to be considered as medical advice, a medical decision, a medical opinion, a diagnosis, or any form of representation to me or any third party. Marveleyes Inc. does not offer medical services or advice, and any information provided by me does not create a doctor-patient relationship or any other professional medical relationship.
I hereby consent to Marveleyes Inc. and its employees and contractors performing the procedure(s) of Semi-Permanent Brow Tattoo and/or Semi-Permanent Brow Tattoo Touch-Up, both now and in any future sessions.I hereby warrant that I have carefully read this Agreement, fully understand its terms and conditions, and acknowledge that by signing it, I will be waiving certain legal rights, including the rights of the minor, my spouse, children, parents, guardians, heirs, next of kin, and any legal personal representatives, executors, administrators, successors, and assigns. I acknowledge that I have signed this Agreement freely and voluntarily, without any inducement, assurance, or guarantee. I 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 governed by and construed in accordance with the laws of the Province of Alberta. If any provision of this Agreement is deemed severable, it shall not affect the validity and enforceability of the remaining provisions.
I further consent to Marveleyes Inc. taking photographs of me both before and after the procedure(s) undertaken by Marveleyes Inc., and at my request. I understand, acknowledge, and authorize Marveleyes Inc. to use these photographs for the purpose of creating an album of its current and past clients to showcase to prospective clients. This includes, but is not limited to, posting on social media platforms such as Facebook and Instagram, and including in Marveleyes Inc.’s training course material and promotional materials related to the procedures performed by Marveleyes Inc. in the normal course of its business. I acknowledge and consent to Marveleyes Inc. retaining these photographs solely for its own files and internal use for the development and monitoring of its services.
I, First Name* Last Name* confirm I have read through , acknowledge, agree, and understand the complete document and the risks and terms of agreement stated above. I acknowledge and give my informed consent to having this and future Semi-Permanent Brow (Nano, Combo, and/or Powder Ombre Brows) procedures and release all liability from Marveleyes Inc and staff in perpetuity. I also affirm that the information I have provided is true and accurate to the best of my knowledge and ability.
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- Semi-Permanent Brows (Nano, Combo, or Powder Ombre Brows) - WAIVER, RELEASE, ASSUMPTION OF RISK, INDEMNITY AND CONSENT AGREEMENT