LED Light Therapy

Name

First Name

Last Name

Informed Consent:

I understand that if I have epilepsy (or have seizures), have light sensitivity or am photo-allergic, or am taking any medication that causes light sensitivity, if I get migraines triggered by light, have skin cancer or any undiagnosed suspicious moles or lesions, if I have thyroid conditions or if I am pregnant, I will inform my Rich Earth Organic Skin Care practitioner I should not receive an LED Treatment, and will either forgo this facial/treatment or opt for a facial/treatment that does not present known contraindications for me. If I am prone to cold sores, if has been recommended that I use cold sore medication several days prior to my LED treatment and several days after.

Release of Liability:

By signing this agreement, I am confirming I understand there may be some inherent risk 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 of 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.

Date

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