Possible Side Effects
Body Treatements are safe when done by a trained technician. But the treatment could cause hormonal brown spots to flare up. You could also have other unwanted side effects, for example.
Your skin could:
- Scar
- Hurt
- Swell
- Hematoma
- Become infected
- Change color
- Get crusty
- Blister
Talk to your technician if you feel sick after your treatment or your symptoms get worse.
Before the procedure, don’t:
- Tan in the sun, in a tanning bed, or with tanning creams for 4 weeks before you go
- Wax, or get a chemical peel or collagen shots for 2 weeks before
CONSENT
I, (hereinafter referred to as THE CLIENT), in regards to DEPILAIS ALTAMONTE, (which is known as the COMPANY), and the treatments, machines and products that I am going to use or will be using on my body and face, the client agrees to the following: release and hereby waive any right to claim any liability against THE COMPANY for all legal matters related to the services provided, equipment, products and/or materials used on my body and/or face. The client acknowledge that the techniques and alternatives have been fully explained to me.
THE CLIENT acknowledge that have no medical conditions that may cause adverse reactions and have fully answered all health-specific questions truthfully. Regarding the use of cosmetic products or cosmetic machinery, the client assume all responsibility for any reaction caused by the machine or application of products given by THE COMPANY.
THE CLIENT accept that any treatment that will be receiving is by their own risk.
THE CLIENT certify that have read, fully understood, and completed this form to the best of their knowledge.
THE CLIENT understand that failure to disclose information requested above may result in adverse side effect(s), unknown because of this to which the client accept full liability/responsibility.
The treatment(s) and possible side effect(s) have been fully explained to the client.
THE CLIENT accept full responsibility for the treatment given and complications which may arise or result during or following any procedure that is performed at the clients request.
THE CLIENT accept that if its not satisfied with the treatment the client will inform the therapist and/or request to speak to the manager during, or immediately following, the treatment.
THE CLIENT fully understand the above and consent to the Body treatment(s) to be carried out.
THE CLIENT understands that cosmetic products may contain ingredients that can cause an allergic reaction in certain people.THE COMPANY is not responsible for claims arising from an allergic reaction.
THE CLIENT its aware that the results obtained with this treatment may vary from person to person, and the client have acknowledge that no promises or guarantees have been made as a result of any treatment performed. The client had the opportunity to ask questions, all the questions have been answered with complete satisfaction. The client have been informed of the products that will be used during any treatment.
THE CLIENT knows that by signing this document, he or she releases THE COMPANY from any claim or complaint related to the formulation, manufacturer and application of the product, treatment applied, machine used or any liability.
THE CLIENT confirms that he or she is over 18 years old AND if he or she is a minor came to our studio accompanied by their representative, the client have filled out and agreed to the performance of the service and signed by the (MINOR CUSTOMER), the authorization to carry out the procedure.
THE CLIENT have read and agrees to the above terms, and fully understands the terms and conditions and signs this consent/release freely and without any cohesion.
THE CLIENT agrees that photos and videos taken during demonstrations, treatments, or shows will be posted on the Company website, newsletters, Company Facebook page, and Company Instagram site. Printed billboard material (posters, postcards, etc.)
THE CLIENT releases DEPILAIS ALTAMONTE, and the Specialist who will carry out said procedure, from any allergy, complication, malpractice by the specialist, rejection of the technical procedure, chemicals, products and/or equipment used before, during and/or after of your consultation, appointment or procedure or any health problem caused by it . Therefore, the client understand the foregoing, accept it and release both the specialist who carried out said service and DEPILAIS ALTAMONTE from guilt and/or responsibility. Because they are events that come out of the hands of the aforementioned.
HIPAA PRIVACY RULE
The department of health and human services has established a "privacy rule" to help ensure that personal health care information is protected for privacy. The privacy rule was also created in order to provide a standard for certain health care providers to obtain their patient consent for uses and disclosures of health information about the patient to carry out treatment, payment or health care operations.
As our patient, we want you to know that we respect the privacy of your personal medical records and will do all we can to secure and protect your privac. We strive to always take reasonable precautions to protect that privacy. When it is appropiate and necessary, we provide the minimum necessary information only to those we feel are in need of your health care operations, in order to provide health care that is your best interest
We also want you to know that we support your full access to your personal medical records. We may have indirect treatment relationships with you (such as laboratories that only interact with physicians and not patients) and may have to disclose personal health information for purposes of treatment, payment or health care operations. These entities are most often not required to obtain patient consent.
You may refuse to consent to the use or disclosure of your personal health information, but this must be in writing. Under this law, we have the right to refuse to treat you should you choose to refuse to disclosure your personal health information (PHI). It you choose to give consent in this document, at some future time you may request to refuse all or part of your PHI.
Yoy may not revoke actions that have already been taken which relied on this or a previously signed consent, if you any objections to this form, please ask to speak with the HIPAA compliance officer. You have the right to review our privacy notice, to request restrictions and revoke consent in writting after you have reviewed our privacy notice.
