BTL demo COnsent

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Informed Consent for BTL Demonstration Treatment

In consideration of the opportunity afforded to me to participate in an event (the “Event”) sponsored by Vibrant Med Spa, Inc. (the “Company”), I hereby agree as follows:

I understand that I’m receiving this treatment for demonstration purposes only, and that I will not receive an entire series of treatments. I understand that completing a full treatment series is necessary to maximize treatment effectiveness.

Initials

I understand that the treatment may involve risks of complications or injury from both known and unknown causes, and I freely assume these risks. I confirm that I do not have any of the following contraindications:

  • Pregnancy and/or breastfeeding
  • Metal or electronic implant in the treatment area
  • Cardiac pacemaker and/or implanted defibrillator
  • Implanted neurostimulators
  • Drug pump(s)
  • Malignant tumor
  • Hemorrhagic condition(s)
  • Epilepsy
  • Recent surgical procedure(s)
Initials

I authorize the Company to use my name, voice, likeness and images (collectively, the “Assets”) in any and all lawful channels, including but not limited to social media, websites, printed or electronic materials, news media, closed circuit television, or advertisements. The Assets may be used for any and all lawful purposes, including but not limited general advertising. I hereby waive all rights to inspect and approve the finished product, its use or such copy as may be used in connection therewith.

Initials

I certify that I have read this entire document and that I agree with all provisions. I certify that I have had the opportunity to ask questions and these questions have been answered in full to my satisfaction. I fully understand the treatment conditions, the procedure and possible side effects.

Initials
Name

I hereby give my consent and authorization, and release the Company, the Administrator of the treatment and their respective owners, agents, representatives, officers, shareholders, employees, partners, directors, attorneys, subscribers, successors and assigns of any claims that I have in the future in connection with the described treatment.