This Agreement is entered into on [Date]
Between:
Lara Belasco, operating under Glow On The Go Beauty Clinic, hereinafter referred to as "Practitioner,"
and
[Client Name], hereinafter referred to as "Client."
1. Purpose of Agreement
The Client agrees to receive non-surgical cosmetic treatments provided by the Practitioner, specifically related to but not limited to Botox, dermal fillers, and other aesthetic services (the "Treatments"). This agreement outlines the understanding, waiver, and limitations of liability between the parties.
2. Acknowledgement of Non-Medical Services
The Client acknowledges and understands that the services rendered by the Practitioner are non-medical aesthetic treatments. These treatments are provided for cosmetic purposes only and should not be interpreted as medical advice, diagnosis, or therapy.
3. Medical Information Disclosure
The Client agrees to provide full, accurate, and complete medical history and relevant health information prior to receiving treatment.
4. No Guarantees of Results
The Client understands and agrees that the Practitioner cannot guarantee specific results or outcomes from any treatment.
5. Assumption of Risk
The Client acknowledges that all aesthetic treatments carry potential risks and side effects, including but not limited to bruising, swelling, discomfort, allergic reactions, infection, and dissatisfaction with the results.
6. Informed Consent
The Client confirms that they have had the opportunity to discuss the proposed treatments, including the potential risks and benefits, with the Practitioner.
7. No Liability for Complications
The Client acknowledges that despite the Practitioner’s qualifications and certifications, complications may still occur.
8. Independent Agreement
This Agreement is entered into freely and voluntarily by both parties, with no external interference or influence.
9. Governing Law
This agreement shall be governed by and interpreted in accordance with the laws of the jurisdiction in which the Practitioner operates.
10. Entire Agreement
This agreement constitutes the entire understanding between the Client and the Practitioner regarding the services provided.
11. Signature and Acceptance
By signing this agreement, the Client acknowledges that they have read, understood, and agree to the terms and conditions outlined above.
Client Signature: ___________________________
Date: ___________________________
Practitioner Signature: ___________________________
Date: ___________________________