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

I understand that there is a possibility of short-term effects such as reddening, mild burning, temporary bruising and temporary discoloration of the skin, as well as the possibility of rare side effects such as scarring and permanent discoloration. These effects have been fully explained to me. *

I certify that I have been fully informed of the nature and purpose of the procedure, expected outcomes and possible complications, and I understand that no guarantee can be given as to the final result obtained. I am fully aware that my condition is of cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so. *

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

I consent to the taking of photographs for my confidential patient file. *

I certify that I have been given the opportunity to ask questions and that I have read and fully understand the contents of this consent form. *

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. *