The Body Wrap

Informed Consent & Release of Liability

Name

First Name

Last Name

Informed Consent:

I understand that if I have serious heat sensitivities, nerve damage that interferes with my ability to sense heat, a serious heart condition, a pacemaker, a serious kidney condition, an untreated or serious thyroid condition, uncontrolled high or low blood pressure, diabetes requiring insulin, cancer, am receiving chemotherapy/radiation therapy, have impaired circulation, rheumatoid arthritis, open wounds, chronic, inflammatory skin conditions such as eczema, psoriasis, dermatitis, hives or rashes, varicose veins, am ill (cold, flu fever), am pregnant or have claustrophobia, I should not receive a body wrap. I will inform my Rich Earth Organic Skin Care Practitioner that I should not receive this treatment, and will either forgo a facial/treatment or else receive a facial/treatment that presents no known contraindications to my specific skin/health issues.

Release of Liability:

By signing this agreement, I am confirming I understand there may be inherent risks associated with receiving facials/treatments and using skin care products, including those provided by Rich Earth Organic Skin Care Studio. I acknowledge and agree I am responsible for my own health; that Rich Earth Organic Skin Care Studio and Rich Earth Organic Skin Care Studio practitioners cannot be expected to diagnose and/or treat individual health problems. By voluntarily choosing to receive facials/treatments and/or use skin care products, I warrant that to the best of my knowledge, I have no condition that is contraindicated for receiving such facials/treatments and using such skin care products. I understand it can be impossible to guarantee or predict a specific aesthetic outcome, so no such guarantee has been made to me. I also understand it can be impossible to predict who may have an unexpected, adverse reaction to a facial/treatment or skin care product, and as such, I acknowledge that I am choosing to receive facials/treatments and to use skin care products of my own free will, with the complete understanding that I cannot hold Rich Earth Organic Skin Care Studio responsible for any inherent risk or unexpected adverse reaction that could occur. In light of the foregoing, I hereby release Rich Earth Organic Skin Care Studio and its practitioners and waive any and all claims, liabilities, or damages for personal injuries that I may experience directly or indirectly from receiving facials/treatments or using skin care products provided by Rich Earth Organic Skin Care Studio.