I duly authorize the staff at Flawless Laser & Body Sculpting Inc. to perform a BLOOD DRAWING PROCEDURE from my left or right arm as discussed with my nurse technician. *

I understand that drawing blood can produce temporary pain from the needle stick, bruising, and rarely, infection. Some patients may experience dizziness, possibly feeling lightheaded, or rarely, fainting. In this case the needle will be removed and the nurse will proceed to keep the patient comfortable. *

I understand that clinical results may vary depending on individual factors, including medical history, patient compliance with pre/post treatment instructions, and individual response to treatment. *

I confirm that I have informed the technician regarding any current or past medical condition, disease or medication taken. *

I hereby expressly waive and release any and all claims which I have or may in the future have against Flawless Laser And Body Sculpting Inc (including their affiliates, and their respective directors, officers, employees, contractors, agents, representatives, shareholders, successors and assigns) (collectively, "Releasees"), arising out of or attributable to receiving the procedure described herein, due to any cause whatsoever, including without limitation the negligence of any Releasee, breach of contract, or breach of any statutory or other duty of care owing under occupiers liability legislation or otherwise. I covenant not to make or bring any such claim against any Releasee, and forever release and discharge all Releasees from liability under such claims. *