Sunrise Spa - Formerly Paradise Spa

Please answer every question. If you answer YES to any question, tell your Sunrise Spa technician before treatment. Treatment may need to be postponed, changed, or declined depending on the Celluma mode and current manufacturer instructions.

List medications, supplements, prescription drugs, or topical products you currently use that may be relevant to light sensitivity. Do not stop a prescribed medication in order to receive LED therapy.

I have been informed that Celluma LED Light Therapy is a non-invasive, low-level light treatment and that individual results vary. I have been informed that no specific result has been guaranteed to me. I have provided accurate and complete information about my health, medications, skin condition, and other relevant circumstances. I have been informed that Sunrise Spa personnel do not diagnose medical conditions or prescribe medication. I have been informed that I may stop the treatment at any time and should immediately report discomfort or unusual symptoms. I agree to follow all treatment, positioning, and eye-safety instructions given by Sunrise Spa personnel. I have been informed that the Celluma manufacturer's current instructions for use and safety requirements apply to the device and treatment.

POSSIBLE TEMPORARY EFFECTS

I have been informed that possible temporary effects may include warmth, mild redness, sensitivity, dryness or tightness, eye discomfort from bright light, headache, temporary irritation, or other individual reactions. Individual responses vary.

EYE SAFETY

I have been informed that the LED light may be bright. I agree to use the eye protection provided or follow my technician's instructions regarding closed eyes and positioning. I will immediately tell my technician if the light causes discomfort.

CONSENT & RELEASE

I voluntarily request Celluma LED Light Therapy at Sunrise Spa. I have been informed that, like any cosmetic or wellness service, the treatment has inherent risks and individual responses cannot be guaranteed. To the fullest extent permitted by applicable Florida law, I release and hold harmless Sunrise Spa, its owners, employees, independent contractors, technicians, and service providers from claims arising from the ordinary risks of the service, except to the extent liability cannot lawfully be waived, including liability for gross negligence, reckless conduct, or intentional misconduct. I have been informed that this document does not waive rights that cannot legally be waived.

I have read this form, understand its contents, have had the opportunity to ask questions, and voluntarily consent to treatment. When called by Sunrise Spa after submission of this form, I agree to provide my credit card information to book the exact appointment time.