We are 100% committed to the health and well-being for everyone. We are doing everything we can to keep potential exposure out of our office.

As part of the local and state guidelines you must answer no to all the following questions each time you enter Pua Manu MedSpa.

Not present a fever over 100 F/ 37 C.
Not presenting cold, cough, difficulty breathing muscle pain, headache,
loss of taste/smell or pink eye in past 5 days.
Not in contact with anyone with these symptoms in the past 5 days.
Not in contact with anyone diagnosed with COVID-19, sick and quarantined, in the past 5 days.
All information above is true. I may be asked again when I arrive for my appointment. 
ALL PATIENTS AND STAFF ARE REQUIRED TO: 

Please follow our local and state regulations and guidelines, including those related to occupancy levels, social distancing and other measures intended to reduce the spread of viruses.
Stay home if you are sick or are exhibiting symptoms of illness such as a fever or persistent cough.
Face mask are required to enter the Spa.
Refrain from shaking hands or other touching rituals.
Wash hands for 60 seconds with soap and warm water prior to treatment or use hand sanitizer.
Refrain from eating or drinking while in the Spa, face mask should not be removed. 
I understand that Pua Manu MedSpa has put in place reasonable safety measures to help reduce the spread of COVID-19.

I understand that I am consenting to an elective treatment/procedure that is not urgent or emergent. I understand that it may put me at increased risk for becoming infected with COVID-19, due to potential community exposure.

PATIENT’S ACCEPTANCE OF RISKS

I consent to accept the risks described above and give my permission to proceed with the treatment/procedure.

I have read this consent or someone has read it to me and want to proceed.

Photos will be taken before, during and after the course of my treatments for medical purposes and to evaluate treatment effectiveness. My photos will be kept confidential in my electronic patient record. If you refuse to take any photos, please understand that we will not be able to perform any treatments on you.

It is almost impossible that you may suffer a physical injury, illness or adverse reaction as a result of undergoing the treatment and therapy offered by microcurrent. If you have any adverse reaction to the administration of the treatment in order to improve the tone and physical appearance of skin and supporting tissue, be sure to immediately contact us and or see a physician for treatment or obtain an appropriate referral for treatment.

The licensed service provider will provide you with a detailed explanation of the treatment. The treatment and therapy offered by microcurrent is not designed or intended to treat, cure, prevent or diagnose any disease, ailgnment or medical condition. No claims offered in relation to the therapy have been evaluated by the FDA. This information is not to be substituted for advice from your physician or health care professional.

It may affect the functioning of any electrical devices used to treat a medical condition (e.g. pacemaker. See below related to these issues). Some people may find this therapy to be strenuous, uncomfortable, disorienting and/or stressful. Therefore, it is recommended that you consult with a physician prior to undergoing therapy.

Skin irritation or redness are possible and may be associated with the use of an electronic muscle stimulator. A doctor should be consulted before using any electronic muscle stimulator, in case you have an underlying medical condition which the electronic muscle stimulator could aggravate.

Sensitive Medications or Skin Conditions

Certain medications, cosmetics or skin conditions may produce a greater sensitivity to the procedure. It is not recommended to undergo therapy if you have been diagnosed with a physical condition affecting the skin. As for medications or cosmetics, typically, these products feature a warning label to notify you of potential adverse effects. Please consult a physician prior to therapy if you are using any such products or medications or have a history of skin problems or believe yourself to be sensitive.

Waiver & Release Signature of Customer

I expressly acknowledge that my use of the therapy is undertaken at my sole risk. Any change in physical activity or routine are done so voluntarily with the complete understanding that I am responsible for all actions and assume all risks of injury, illness, disease or death.

Pua Manu MedSpa is also not responsible for loss of any personal property. This waiver and release of liability includes, without limitations, all injuries that may occur as a result of (a) use of equipment or products applied topically in conjunction with the equipment (b) the sudden and unforeseen malfunction of the equipment (c) slipping or falling on the premises – including adjacent sidewalks, parking lots, etc.

Contra-indications:

People with physical or mental limitations, have an implanted or other electrical stimulatory device (pacemakers, implanted or other electronic nerve), a history of seizures, epilepsy, or who are pregnant, have active cancer should not undergo the treatment and therapy offered by microcurrrent. 

Discounted or special priced treatments must be prepaid in full by first treatment appointment. Incomplete and/or cancelled treatments will be charged at regular/full price, NO refunds.

I release Pua Manu MedSpa, their providers, estheticians, and any other staff member, affiliate, or independent contractor from any and all liability associated with any injuries and/or current or future conditions resulting from the treatment of microcurrent and/or products.

Photos will be taken before, during and after the course of my treatments for medical purposes and to evaluate treatment effectiveness. My photos will be kept confidential in my electronic patient record. If you refuse to take any photos, please understand that we will not be able to perform any treatments on you.

By signing below, I certify that I have read and fully understood the contents of this consent form, and that the information I provided above are complete, accurate, and up-to-date to my knowledge. I acknowledge that I have read and understand all information presented to me before signing this consent form. I have consulted with the Esthetician, Nurse and/or Dr. prior to treatment and understand the treatment procedure and risks. I have been given an opportunity to have all my questions answered to my satisfaction. I also understand that we may consult at any time after the initial consultation to update the treatment as necessary. I understand and agree that it is my sole responsibility to comply with all information given regarding before and after care. I will not hold the Esthetician, Pua Manu MedSpa or it's Staff, Dr. Nancy Chen or Kapolei Eye Care responsible or liable for any noncompliance on my part or for any damages incurred otherwise.