Model Treatment Consent and Release Form
  • Model Treatment Consent and Release Form

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  • I acknowledge that treatments, the practice of skin care, and the practice of massage, including, but not limited to, facial toning, body treatments, laser treatments, IPL treatments, vein treatments, brown spot removal, microneedling, waxing, tooth gems, facial and body peeling, dermaplaning, injectables and various other beauty procedures is not an exact science and no specific guarantees can or have been made concerning the outcome. I understand that some clients experience more change and improvement than others. In virtually all cases, multiple treatments are required in order to realize a difference.

  • I also understand and agree to assume the following risks and hazards which may occur in connection with any particular treatment including but not limited to: unsatisfactory results, soreness, poor healing, discomfort, redness blistering, nerve damage, scaring, infection and change in skin pigmentation, allergic reaction, muscle damage, and increased hair growth. I understand that even though precautions may be taken in my treatment, not all risks can be known in advance. In case of emergency contact Dr. Don Hedges DO at Northwest Medical Center 505-345-3572 or norhtwestmedicalcenterinc.com

  • Given the above, I understand that response to treatment varies on an individual basis and that specific results are not guaranteed. Therefore, in consideration for any treatment received, I agree to unconditionally defend and hold harmless and release from any and all liability the company and the individual that provided my treatment, the insured and any additional insureds, as well as any officers, directors,  employees, agents, representatives, successors or subsidiaries of the above companies for any condition or result, known or unknown, that may arise as a consequence of any treatment that I receive.

  • I have fully disclosed on my client intake form any medications, previous conditions or complications, or current conditions that may affect my treatment. I understand and agree that any legal action of any kind related to any treatment I receive will be limited to binding arbitration using a single arbitrator agreed to by both parties.

  • Model Release

    In consideration for treatment received, I hereby grant permission to the individual or company that provided my treatment to use any photographic treatment records for the purposes of clinical and statistical studies, advertising, or promotion without any compensation to me. I will be made avalible in person at Halo Med Spa durring business hours in 7-10 days post procedure for after photos an follow up. 

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