Lymphatic Drainage

Name

First Name

Last Name

Informed Consent:

I understand that if I have any acute inflammation, malignant tumors, heart issues (such as congestive heart failure), a history of blood clots or strokes, kidney issues, liver issues, bronchial asthma, thyroid issues, edema, thrombosis, hypertension, diabetes, am undergoing chemotherapy/radiation therapy, am pregnant, am ill (cold, flu, fever, etc) or have any active infection, I should not receive lymphatic drainage, and will inform my Rich Earth Organic Skin Care Practitioner that I should not receive the Manual Lymphatic Drainage treatment, and will opt to forgo this treatment and/or opt for a facial/treatment that does not present known contraindications.

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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