Liability Laser Waiver

LIABILITY LASER WAIVER

This Liability Laser Waiver (the Agreement) is made and entered into on by and between Provider Name: with business address , and Client Name: of address .

RECITALS

WHEREAS, Provider is duly qualified and equipped to perform laser procedures and related services in the scope of cosmetic, dermatological or medical aesthetic treatments; and

WHEREAS, Client desires to receive one or more laser procedures from Provider and acknowledges that such procedures involve inherent risks, including but not limited to burns, scarring, pigmentary changes and allergic or other adverse reactions; and

WHEREAS, the parties wish to set forth their understanding and respective rights, obligations and releases with respect to the provision of laser procedures;

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. DEFINITIONS

"Laser Procedures" means all pre-treatment consultations, laser treatments, post-treatment protocols, photographs and ancillary procedures performed by Provider or under Provider's supervision. "Provider" includes the practice, its owners, officers, employees, contractors and agents. "Client" includes the undersigned individual and, where applicable, the individual's heirs, assigns and legal representatives.

2. ACKNOWLEDGMENT OF RISKS

Client acknowledges that Laser Procedures may involve risks including without limitation: thermal injury or burns; scarring; pigmentary alteration (hyperpigmentation or hypopigmentation); infection; delayed healing; pain or discomfort; eye injury if appropriate eye protection is not used; paradoxical hair growth; and unsatisfactory cosmetic result. Client acknowledges that such risks may be permanent and that specific complications cannot be guaranteed to be avoided.

3. HEALTH REPRESENTATIONS AND CONTRAINDICATIONS

Client represents that Client has fully and accurately disclosed all medical history, current medications, past surgeries, skin conditions and allergies. Client certifies that Client is not pregnant or breastfeeding unless Client has disclosed pregnancy and obtained medical clearance.

Pregnant or breastfeeding
Is or has recently been taking isotretinoin (Accutane) within the last 6 months
Uses photosensitizing medications or has a history of photosensitivity
Has implanted medical device or pacemaker
History of autoimmune disease or impaired wound healing

4. CONSENT TO TREATMENT

Client voluntarily consents to the performance of Laser Procedures and any ancillary procedures deemed necessary by Provider. Client authorizes Provider to administer topical or local anesthetics when appropriate and to take standardized clinical photographs for treatment assessment, recordkeeping and training purposes. Client consents to such photographs and acknowledges that such images may be used in de-identified form for educational purposes.

5. PRE- AND POST-TREATMENT INSTRUCTIONS

Client agrees to follow Provider's written and verbal pre- and post-treatment instructions. Client acknowledges that failure to follow such instructions may increase the risk of complications and may impair the outcome of the Laser Procedures. Provider shall not be liable for complications resulting from Client's failure to comply with instructions.

6. RELEASE AND WAIVER OF LIABILITY

Except as otherwise provided in this Agreement, Client, on behalf of Client and Client's heirs, assigns and personal representatives, hereby releases, waives, discharges and covenants not to sue Provider and Provider's officers, employees, agents and contractors (the Released Parties) from any and all liability, claims, demands, actions or causes of action arising out of or related to any loss, damage, injury or death, including claims arising out of ordinary negligence, resulting from or connected with the Laser Procedures. This release does not extend to claims arising from the gross negligence or willful misconduct of a Released Party.

7. INDEMNIFICATION

Client agrees to indemnify, defend and hold harmless the Released Parties from and against any and all losses, liabilities, damages, claims and expenses (including reasonable attorneys' fees and costs) arising from Client's breach of this Agreement, Client's negligence or intentional misconduct, or any third-party claims related to Client's treatment, except to the extent caused by the gross negligence or willful misconduct of a Released Party.

8. ACKNOWLEDGMENT OF NO GUARANTEE

Client acknowledges that Provider has made no guarantee or warranty regarding the results of Laser Procedures. Client understands that multiple treatments may be necessary and that outcomes vary by individual.

9. NOTICES

Any notice required or permitted under this Agreement shall be in writing and shall be delivered to the other party at the address set forth below or to such other address as either party may designate by notice delivered in accordance with this Section.

10. AMENDMENTS; WAIVER

No amendment, modification or waiver of any provision of this Agreement shall bind any party unless set forth in a written instrument signed by the party to be bound. The failure of any party to enforce any right shall not constitute a waiver of such right or any other right.

11. GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State specified below, without regard to its conflict of laws principles.

12. ENTIRE AGREEMENT; SEVERABILITY

This Agreement contains the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements and understandings, oral or written. If any provision of this Agreement is held to be invalid, illegal or unenforceable the remaining provisions shall remain in full force and effect.

13. COUNTERPARTS; ELECTRONIC SIGNATURES

This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument. Signatures transmitted by electronic means shall have the same force and effect as original signatures.

Initials: I have read and understand the risks described above.

Initials: I consent to the proposed Laser Procedures and authorize Provider to perform them.

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