Terms and Conditions

NEUROMODULATORS PATIENT CONSENT

Please ensure you have all your questions answered before signing.

THE TREATMENT

I am aware that a neuromodulator (BOTOX© Cosmetic, Dysport©, Xeomin©) is injected into a muscle that causes a temporary reduction in the strength and of muscle contraction (the “procedure”). This effect may start to occur in 2-4 days after injection and full results within 14 days. The duration of the effect on average is 3 months but can be shorter or longer. I understand that the goal of treatment is to soften the muscle contraction and not to eliminate the movement completely. Treatment, however, may reduce or eliminate my ability to “frown,” produce “crow’s feet,” forehead “worry lines,” and/or reduce other facial lines. Neuromodulators do not affect well-established and deep wrinkles. After injection, I agree to stay in an upright position for 3-4 hours to prevent migration of the product to other muscle. I will contract the muscles that were injected every few minutes for 1 hour to ensure the neuromodulator is absorbed into the muscle injected. I agree to not massage or manipulate the area for 3 hours after injection. I understand that re-treatment of the area with a neuromodulator can result in an increase in the risk of unwanted side effects such as migration and eyelid droop. I am aware that at any time I can develop a tolerance to a neuromodulator that can appear as a reduction in effect or reduction in length of time the muscle is weakened. I understand that it is in my best interest to avoid blood thinners such as aspirin products, aspirin products, non-steroidal anti-inflammatory drugs, high dose garlic, ginkgo, and/or other herbal supplements up to 3 days before treatment. 

I understand that neuromodulators may be applied in areas that are considered “off label” by the manufacturer and Health Canada. BOTOX© Cosmetic is only approved for glabella, forehead, and crow’s feet. Dysport© is approved for glabella and crow’s feet. Xeomin© is approved for glabella. My injector may recommend “off label” for other areas including but not limited to: lower face, neck, ect.

RISKS AND COMPLICATIONS
Before undergoing the Procedure, understanding the risks is essential. No procedure is completely risk free. The following risks may occur, but there may be unforeseen risks and risks that are not included on this list. I understand that neuromodulators can cause temporary eye droops in up to 2% of all injections and that this is a risk each time I receive an injection. This effect can last up to 4 months. Possible side effects include diplopia, transient headaches, bruising, redness, swelling at the site of injection, flu-like symptoms, infection and/or transient numbness. Bruising can last up to 7 days and be substantial in size or color depending on the area injected. When the lower face is injected with a neuromodulator, there is a risk of change in lip pursing, ability to enunciate words, sip from a straw or cup and/or mouth droop. This effect is temporary. In rare cases, bleeding and allergic reactions may occur.

Please initial below:

_____ I am aware and understand that my results are not guaranteed and may or may not fall within the expected outcomes and I freely accept and fully assume all risks and dangers from my elective participation in the Procedure. 

RELEASE OF LIABILITY:

_____ I freely waive any and all claims that I have or may in the future against Erin Pedneault (the “Registered Nurse”) and Beauty and Health by Erin (the “Clinic”) and any individual or corporation that is associated with the Registered Nurse or the Clinic (collectively, the “Releasees”).

_____ I agree to waive my rights to sue the Releasees for any cause whatsoever associated with my participation in this elective procedure including negligence or breach of any statutory or other duty of care on the part of the Releasees, including a failure on the part of the Releasees to safeguard or protect me from any risks and dangers associated with my participation in the Procedure. 

_____ I agree to hold harmless and fully indemnify the Releasees from any claims or demands, which may be made against any one of them, either alone or in combination, arising out of or as consequences of my participation in the Procedure.

PHOTOGRAPHS

_____ I authorize the taking of clinical photographs and their use for my personal treatment. I understand my identity will be protected. 

PREGNANCY, ALLERGIES, NEUROLOGICAL DISEASE & MEDICAL CONDITIIONS

_____ I am NOT pregnant. I am not trying to get pregnant. I am not lactating (nursing). 

_____ I do not have allergies to the neuromodulator or anesthetic ingredients, or to human albumin.

_____ I do not have any significant neurological or neuromuscular disease (e.g., muscular sclerosis). 

_____ I am not taking tetracycline or any aminoglycoside antibiotics.

_____ I have fully disclosed all medical conditions/concerns prior to treatment and do not have any illnesses that would prohibit me from the Procedure.

PAYMENT

_____ I understand that this is an elective Procedure and that payment is my responsibility and is expected at the time of treatment. All patients require an initial consultation and are not required to have treatment on their initial visit. However, patients can elect to have treatment performed on the day of consultation. 

______ I have read the above and understand it. My questions have been answered satisfactorily. I have been made aware of alternative methods of treatment. I accept the risks and complications of the Procedure and I understand that no guarantees are implied as to the outcome of the Procedure. I am aware that by signing this waive, I am waiving substantial legal rights on my behalf and on behalf of my heirs, executors, administrators and next of kin. I agree to being governed by the laws and statues of Alberta, Canada.

DERMAL FILLER PATIENT CONSENT

Please ensure you have all your questions answered before signing.

THE TREATMENT

Hyaluronic acid fillers are injectable gels that are used to restore volume to the skin, correct facial lines, wrinkles, and folds as well as to alter facial contours (the “Procedure”). Fillers are temporary and can last from 6 to 24 months depending on the skin type, type of filler used, the location injected, and the number of syringes used. Additional treatments may be required periodically, involving additional injections for the effect to continue. I am aware that follow up treatments will be needed to maintain full effects. In the first few days after injection the filler is moveable. I understand that I am not to manipulate the area injected and I should sleep on my back. I understand that it is in my best interest to avoid blood thinners such as alcohol, aspirin products, non-steroidal anti-inflammatory drugs, high dose garlic, ginseng, gingko and/or other herbal health supplements up to three days before treatment. I understand I am to avoid strenuous physical exercise, hot tub, saunas, facials, alcohol, aspirin products and/or non-steroidal anti-inflammatory drugs for 24 hours after treatment.

RISKS AND COMPLICATIONS
Before undergoing the Procedure, understanding the risks is essential. No procedure is completely risk free. The following risks may occur, but there may be unforeseen risks and risks that are not included on this list. The use of and indications for dermal filler injection has been explained to me and I have had the opportunity to have my questions answered. I understand that after injections, it is common to experience pain at the site of injection, redness, swelling, bruising, itching, granuloma (nodule), edema, infection and/or discoloration. Bruising/swelling can be quite substantial and last 7 days or longer. I understand that Herpes Simplex Virus (cold sore) eruption may result in cases where filler is injected in a treated area that has previously been infected with the virus (typically true with lip fillers). These reactions typically resolve spontaneously. The initial swelling after lip treatment may last longer, with swelling for about 1 week with lips looking somewhat uneven during this time, therefore the result immediately after treatment should not be looked upon as the final result. Other types of rare reactions include hypersensitivity or allergic reaction to the filler or anesthetic, keloid scarring, asymmetry, and pigment changes. An extremely rare adverse event is arterial or vein embolism. This occurs when the gel is injected into the blood vessel and can result in severe skin breakdown/necrosis or blindness. Filler can move from the site of injection when under pressure and this can result in facial asymmetry. With lip injections, there is possibility of provoking a cold sore (herpes) infection.

I understand that Hyaluronic acid fillers may be applied in areas that are considered “off label” by the manufacturer and Health Canada, Depending on patient request, my injector may consider injecting products in ways that are considered “off label” to obtain desired results, and I understand that this is not the products intended use.

Please initial below:

_____ I am aware and understand that my results are not guaranteed and may or may not fall within the expected outcomes and I freely accept and fully assume all risks and dangers from my elective participation in the Procedure. 

RELEASE OF LIABILITY:

_____ I freely waive any and all claims that I have or may in the future against Erin Pedneault (the “Registered Nurse”) and Beauty and Health by Erin (the “Clinic”) and any individual or corporation that is associated with the Registered Nurse or the Clinic (collectively, the “Releasees”).

_____ I agree to waive my rights to sue the Releasees for any cause whatsoever associated with my participation in this elective procedure including negligence or breach of any statutory or other duty of care on the part of the Releasees, including a failure on the part of the Releasees to safeguard or protect me from any risks and dangers associated with my participation in the Procedure. 

_____ I agree to hold harmless and fully indemnify the Releasees from any claims or demands, which may be made against any one of them, either alone or in combination, arising out of or as consequences of my participation in the Procedure.

PHOTOGRAPHS

_____ I authorize the taking of clinical photographs and their use for my personal treatment. I understand my identity will be protected. 

PREGNANCY, ALLERGIES, NEUROLOGICAL DISEASE & MEDICAL CONDITIIONS

_____ I am NOT pregnant. I am not trying to get pregnant. I am not lactating (nursing). 

_____ I do not have allergies to dermal fillers or anesthetic (including lidocaine) ingredients, or to bee/wasps.

_____ I do not have any significant neurological or neuromuscular disease (e.g., muscular sclerosis). 

_____ I am not taking tetracycline or any aminoglycoside antibiotics.

_____ I have fully disclosed all medical conditions/concerns prior to treatment and do not have any illnesses that would prohibit me from the Procedure.

PAYMENT

_____ I understand that this is an elective Procedure and that payment is my responsibility and is expected at the time of treatment. All patients require an initial consultation and are not required to have treatment on their initial visit. However, patients can elect to have treatment performed on the day of consultation. 

______ I have read the above and understand it. My questions have been answered satisfactorily. I have been made aware of alternative methods of treatment. I accept the risks and complications of the Procedure and I understand that no guarantees are implied as to the outcome of the Procedure. I am aware that by signing this waive, I am waiving substantial legal rights on my behalf and on behalf of my heirs, executors, administrators and next of kin. I agree to being governed by the laws and statues of Alberta, Canada.

EYELASH EXTENSIOCONSENT/WAIVER

By signing below, I am agreeing to the following (please initial each):

_____ I understand that there are some risks associated with having artificial eyelash extensions applied to and/or removed from my existing lashes. This includes, without limitation: eye irritation, allergic reaction, redness and/or discomfort, which may require follow up care at my own expense. I also agree to defend, indemnify, and hold harmless Beauty & Health by Erin and the lash artist applying eyelash extensions on me against any and all claims, actions, expenses, damages, and liabilities including reasonable attorney’s fees, which might be asserted against the company (and artist) as a result of my having this procedure performed or my purchase of any products.

_____ It is my responsibility to advise the technician of any concerns I may have before participating as a client/customer and having this service performed on me. I have been given the opportunity to ask questions, either by written or verbal communication, prior to signing this Release. As a result, I have sufficient information to give this informed consent. 

_____ I understand my participation as a client may be refused depending on my intake responses, including but not limited to, if I am pregnant, nursing, or if I have any allergies or contraindications.

_____ I understand that no warranty or guarantee has been made as a result of the services, and that the final result cannot be guaranteed as each skin/hair type is unique.

_____ I am aware of the appointment time and agree to lay still with my eyes closed during the entire appointment until my technician advises me to open my eyes. Opening my eyes during an appointment can expose them to fumes of the glue, which could lead to irritation such as watering, burning, and redness. If I do experience and of the listed effects, I will notify my technician immediately.

_____ I have been advised of the potentially harmful and negative side effects (such as premature lash shedding) that the procedure may cause to those that have specific medical or skin conditions. I agree to disclose any allergies I may have. 

_____ I understand that because of the natural lash cycle and wear and tear, a fill is recommended every 2-4 weeks to maintain the fullness of the appearance. Anything short of 50% of the original set remaining is no longer considered a fill, but rather a full set and will require additional times and fees.

_____ I have been provided with and have a thorough understanding of the aftercare instructions. Since the aftercare plays a significant role in the longevity of the extensions, my technician will not be liable for premature shedding of the extensions. If follow up is required due to my own mistake/negligence/failure to follow instructions, this will be at my own expense and risk.

_____ If I experience any itching, irritation or develop any symptoms of allergies after having my eyelashes done, I will contact my technician immediately and if needed, have my eyelash extensions removed.

_____ I give consent for photographs to be taken of my lashes and be used for portfolio, flyers, posters, business cards, and online advertisement.

_____ I agree to be added to the salons mailing list for promotions, events, announcements, ect.

This agreement will remain in effect for this procedure and all future procedures conducted by Technicians at Beauty & Health by Erin. I will notify the technician of any changes.

I have completely read in full, understand the above stated, and wish to proceed with the services.