PLEASE READ CAREFULLY TO FINALIZE BOOKING

This agreement is entered into by , herein referred to as 'CLIENT(S)' and THE BELLO GROUP, INC DBA CHIOMA, herein referred to as 'TBGI'.

I, , agree to electronic records and e-signature. My signature acknowledges that I have READ the following and AGREE to receive treatment or a series of treatments from TBGI

I agree and consent that the completion of this form, whenever booking Services via online (or through mobile app), purchase of Services or use of the Services constitutes an authorized signature, acceptance and agreement to the terms and conditions of this Waiver as if actually signed in writing. Further, I agree that no certification authority or other third party verification is necessary to the validity of electronic signature on this agreement. I agree that the lack of such certification or third party verification will not in any way affect the enforceability of the electronic signatures on this agreement or any resulting contract between myself and the TBGI.

I consent to electronic records and e-sginature

I, , consent to members of TBGI, to perform SAUNA, SCULPT, BODY WRAPPING or BODY TREATMENT, which may include ANY or COMBINATION OF THE FOLLOWING TREATMENTS PERFORMED ON ANY PART OF THE BODY: INFRARED & STEAM SAUNA, BODY WRAPPING, LED RED LIGHT THERAPY, EMS/ELECTRO SCULPTING, MADEROTHERAPY/VACUUM THERAPY and ULTRASONIC CAVITATION.

TREATMENT DESCRIPTIONS & CONSENT

INFRARED & STEAM SAUNA:

Saunas are a therapeutic, heated, enclosed, wood-lined room or devices that generate intense heat within the sauna to encourage detoxifying perspiration, relief from aches and pains, and deep relaxation.

INFRARED & STEAM SAUNA RISKS: Just as there may be benefits to the procedure proposed, I understand that all procedures involve risks to some degree. Risks can include but not limited to: HEAT DISCOMFORT, LIGHT-HEADEDNESS, TRANSIENT LEG PAIN, AIRWAY IRRITATION, DEHYDRATION. 

INFRARED & STEAM SAUNA CONTRAINDICATIONS: Pregnancy, Hemophilia / Prone To Bleeding, Recent Fever, Vomiting or Diarrhea, Recent Joint Injury or Surgery, Multiple Sclerosis, Central Nervous System Tumors, Diabetes, Neuropathy. 

BODY WRAPPING:

Body wrapping treatments works to firm and strengthen the muscle using low electric pulses to create muscle contractions.

BODY WRAPPING RISKS:  Just as there may be benefits to the procedure proposed, I understand that all procedures involve risks to some degree. BODY WRAPS may produce but not limited to: DISCOMFORT FROM SWEATING, REDDENING OF THE SKIN, SWELLING, PEELING, BRUISING, ALTERED SENSATIONS AND PIGMENT CHANGES.

BODY WRAPPING CONTRAINDICATIONS: Oncological diseases, Circulatory Disorders, Diabetes, Pregnancy and Lactation, Tendency to allergies and individual intolerance to certain ingredients, essences aromas, Varicose veins, Thrombophlebitis, Cold, viral or chronic diseases in the acute stage, Skin diseases or injuries at the site of the procedure (injuries, wounds, inflammation, etc.), Menstruation.

LED/RED LIGHT THERAPY:

LED/Red Light Therapy treatment uses light technology to stimulate collagen production. The high intensity light technology targets problem areas by helping to break down stubborn fat cells.

LED/RED LIGHT THERAPY RISKS: Just as there may be benefits to the treatment proposed, I understand that ALL procedures involved risk to some degree. The Lipo Sculpt Light/LED Laser Lipo may produce but not limited to: DISCOMFORT FROM LIGHT PENETRATION, REDDENING OF THE SKIN, SWELLING, PEELING, BRUISING, ALTERED SENSATIONS AND PIGMENT CHANGES.

LED/RED LIGHT THERAPY CONTRAINDICATIONS: Oncological diseases, Open wounds or Damaged Skin, Metastatic Lesions, Vascular Abnormalities, Deep Vein Thrombosis, Severe Atherosclerosis, Metal Implants, Implanted Electronic Devices, Use of photosensitizing medications (i.e. lithium, melatonin, phenothiazine antipsychotics, and certain antibiotics), Diseases that involve the retina of the eye, Pregnancy or Lactation.

ULTRASONIC CAVITATION:

Ultrasonic cavitation treatment includes but is not limited to: the use of high power low frequency ultrasound cavitation using 25khz to 40khz frequency ultrasound to penetrate the skin and assist with the breakdown of fat cells.

ULTRASONIC CAVITATION RISKS: Just as there may be benefits to the procedure proposed, I understand that all procedures involve risks to some degree. The ultrasound cavitation treatment may produce but not limited to: LIGHT BUZZING noise in the ear. Clients may experience TINGLING or HEATED SENSATION. Other common side effects include REDDENING, MINOR SWELLING OR TEMPORARY BRUISING. Ultrasonic cavitation may cause other possible but EXTREMELY RARE health complications including but not limited to: THE RISKS OF KIDNEY FAILURE, LIVER FAILURE, PACEMAKER FAILURE, BIRTH DEFECTS, MISCARRIAGE, HYPERCHOLESTEROLEMIA, PANCREATITIS, INFECTION, SCARRING, ALLERGIC REACTIONS TO ANY PRODUCTS USED, EXCESSIVE THIRST, DEHYDRATION AND NAUSEA.

ULTRASONIC CAVITATION CONTRAINDICATIONS: Oncological diseases, Cold or flu symptoms or fever, Swollen lymph nodes, Edema, Active Infections,& Immunosuppression, Liver, Kidney, or Heart Disease, Severe Hypertension > 200/100, hyperlipidaemia, diabetes mellitus, Pregnancy, Breastfeeding, Diabetes type 1 and type 2 should check their blood sugar 1 hour before coming, Clients with hyperlipidemia (high cholesterol) should be on medication. Clients who have been diagnosed AND are not compliant (taking medication as instructed) are not eligible for body contouring treatments such as cavitation.

EMS/ELECTRO SCULPTING:

EMS/Electro Sculpting treatment uses faradic or galvanic current to tone and reshape.

EMS/ELECTRO SCULPTING RISKS: Just as there may be benefits to the procedure proposed, I understand that all procedures involve risks to some degree. The EMS/Electro Sculpting may produce DISCOMFORT FROM MUSCLE STIMULATION, REDDENING OF THE SKIN, SWELLING, PEELING, BRUISING, ALTERED SENSATIONS AND PIGMENT CHANGES.

EMS/ELECTRO SCULPTING CONTRAINDICATIONS:  Oncological diseases, Open wounds or damaged skin, Varicose vein treatment vein and Telangiectasia, Phlebitis or blood clots, Pregnancy or lactation, Pacemaker, Metal Implants, Diabetes(may cause hematoma easily).

MADEROTHERAPY/VACUUM THERAPY:

Maderotherapy/Vacuum Therapy holistic sculpting treatment that involves the application of a wooden or metal tools and cups of different sizes, especially designed to adapt to different parts of the body to sculpt, tone and shape the body.

MADEROTHERAPY/VACUUM THERPAY RISKS: Just as there may be benefits to the procedure proposed, I understand that all procedures involve risks to some degree. The MADEROTHERAPY/VACUUM THERAPY treatment may produce but not limited to: DISCOMFORT FROM SWEATING, REDDENING OF THE SKIN, SWELLING, PEELING, BRUISING, ALTERED SENSATIONS AND PIGMENT CHANGES.

MADEROTHERAPY/VACUUM THERAPY CONTRAINDICATIONS:  Oncological diseases, Open wounds or damaged skin, Varicose vein treatment vein and Telangiectasia, Phlebitis or blood clots, Pregnancy or lactation, Diabetes(may cause hematoma easily).

PLEASE NOTE THE CONTRAINDICATIONS MENTIONED ABOVE ARE JUST A GUIDE AND DOES NOT CONSTITUTE FOR MEDICAL ADVICE. WE CAN NOT EVALUATE ANY OF YOUR MEDICAL CONDITIONS, MEDICATIONS, ALLERGIES OR SURGERIES IN REGARDS TO THE SAFETY OF ANY OF OUR SERVICES. IF YOU HAVE ANY QUESTION ABOUT THE STATUS OF YOUR HEALTH, PLEASE CONSULT YOUR PHYSICIAN BEFORE ENGAGING IN ANY SERVICES/PROCEDURES. BY CONTINUING WITH TREATMENT YOU ACKNOWLEDGE THAT YOU HAVE READ AND UNDERSTAND ALL THE ASSOCIATED RISKS AND ASSUME ALL RISKS.

 I HAVE READ AND CONSENT THAT TBGI AND ITS ASSOCIATES CANNOT EVALUATE MY MEDICAL STATUS AND I AM RESPONSIBLE TO CHECK WITH MY MEDICAL PROVIDER BEFORE STARTING ANY TREATMENTS AT TBGI.

ACKNOWLEDGMENT OF TREATMENT TERMS

I, , acknowledge that I have read and understood the descriptions, risks, and contraindications for all services provided, including: Infrared & Steam Sauna, Body Wrapping, LED Red Light Therapy, Ultrasonic Cavitation, EMS/Electro Sculpting, and Maderotherapy/Vacuum Therapy. By signing below, I certify that I have read these descriptions in full, have had sufficient time to consider the information, and am sufficiently advised to consent to these procedures.

CONTRAINDICATIONS CONSENT

I, , agree to the following conditions

• I understand that while sauna therapies, body wraps and body contouring treatments are relatively very safe treatments, they are recommended for those in good health. Clients with active Active Cancer, Lymphatic Disorders, Immunosuppression Disorders, Severe Kidney and Liver Diseases, Severe Diabetes, Severe Hypertension, Pregnancy, Edema and Progressive Diseases (MS, ALS, Parkinson’s, neuropathy) ARE CONTRAINDICATED for ALL body treatments are not eligible for Sauna, body wrapping or body treatments treatments at TBGI.
• Clients who have an active diagnosis of ANY KIND are AND are not compliant (taking medication as instructed) are not eligible for body treatments.
• Clients with active communicable infections (.i.e COVID 19, cold sores etc) MAY NOT schedule ANY appointments until they have been formally cleared to do so.
• I understand that if I meet any of the above conditions, I am not eligible for body treatments at TBGI unless approved via a FORMAL NOTE from your physician and MAY NOT continue with the appointment booking. Failure to adhere to the policy or communicate immediately to the TBGI any pre existing conditions is considered a breach of agreement and thereby releases TBGI, its affiliates, staff and representatives of any liability.
• I understand that I will consult a physician before engaging in any services/procedure at TBGI. TBGI, its staff, affiliates, partners or employees can not evaluate any of my medical conditions, medications, allergies or surgeries in regards to the safety of any of its services.

If you have a formal note of treatment consent from your physician, please upload it here

TREATMENT CONSENT

I, , agree and consent to the following conditions:

• The nature and purpose of the treatment has been FULLY described to me and I willingly assume all risks associated with the service(s) that I am voluntary choose to do.
• I have received, fully READ and consent all the terms and policies indicated in the digital service policies.
• I understand that with any treatment certain risks are involved and that any complications or side effects from known or unknown causes could occur which may include and are not limited to reddening, pigment changes, altered sensations, discomfort, swelling, scarring, bruising and permanent changes to body symmetry. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, AND HOLD HARMLESS, RELEASE, INDEMNIFY AND DEFEND, TBGI ITS SUBSIDIARIES AND AFFILIATES, THEIR RESPECTIVE OFFICERS, DIRECTORS, AND EMPLOYEES FROM ANY LIABILITY, CLAIMS, DEMANDS, ACTIONS AND CAUSES OF ACTION WHATSOEVER WHICH MAY BE ASSOCIATED WITH AND/OR RESULT FROM MY INVOLVEMENT IN SUCH AN ACTIVITY AND/OR ARISING OUT OF OR RELATING TO ANY SERVICES AND/OR SPA TREATMENT OBTAINED BY ME AT TBGI EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation.
• I have been advised that the body treatments offered at TBGI is recommended only for people in good health and not for excessively overweight or obese. I have clearly and freely expressed that I am in good health and do not have any contraindications and/or compliant with ALL prescribed medications.
• I have also been advised to communicate immediately to the TBGI after starting the treatment if my health conditions change, in order to stop or modify treatment.
• I have been advised that any weight loss specific treatments work ONLY when combined with healthy lifestyle habits, therefore it is advised to follow healthy nutrition habits, to drink at least 1.5-2 liters of water a day and engage in at least 30 minutes of exercise a day. Results will vary and there are no guarantees or claims to results.
• I understand that NO Refunds are issued on completed services. No exceptions. A complimentary service at the FULL DISCRETION of spa manager is the sole remedy
• I understand that ANY unused treatments will expire after 12 months from purchase date. Monetary refunds are NOT issued for unused services. In the event that a client cannot continue with treatments, all unused services are non refundable.
• CANCELLATION POLICY - I understand that ANY cancellations within 24 hours of your scheduled appointment is non refundable and customer is responsible for 100% of the treatment cost. I understand that treatments rooms, equipment and staff are solely assigned to their appointment and that any no-shows, late cancellation (without a minimum of 24 hours notice), will be charged 100% of the full cost of the treatment and is nonrefundable. Cancellation policy for group and custom appointment(s) - For custom and group appointments (3 ore more people), a minimum of 7 days prior to appointment time is required to make any modifications to the appointment. Cancellation made within the 7 days and at least 48 hours before the scheduled appointment will be charged at 50% of the cost of service, after 48 hours customer(s) is responsible for 100% of the service and cost is non-refundable.
• LATE POLICY - I understand a maximum of 10 minute grace period from appointment start time may be granted at the FULL discretion of the spa manager. Please be aware that late arrivals will not be afforded extension of scheduled treatments and you will still be responsible for the 100% cost of the service.
• I am over 18 years of age and I have freely decided to contract this treatment.
• I understand and voluntarily accept the risks associated with the use of TBGI location’s facilities including but not limited to equipment, treatments, treatment beds, chairs, products and accessories. I agree TBGI, it’s parent, subsidiaries and affiliate companies will NOT be liable for any injury, including, without limitation, personal, bodily or mental injury, economic loss or damage to me resulting from negligence, other acts i, anyone acting on TBGI’s behalf, or anyone using the services of the facilities of TBGI, to the fullest extent permitted by law. This agreement together with TBGI rules and regulations, constitute the entire agreement between you and us and cannot be amended, except in writing by both parties. Myself and/or any of my heirs, executors, representatives, or assignees hereby release TBGI from ALL claims or liabilities for death, personal injury or property loss or damages of any kind sustained while on the premises and/or from any advice or services provided by an employee, independent contractor or any representative of TBGI . I agree that this application and waiver is in effect for ALL Sessions or any other services, and will NOT expire.
• I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT , FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
• FORCE MAJEURE. TBGI will not be liable for any delay or failure to perform its obligation under this Agreement if prevented from doing so by acts of God, acts of war or civil disturbance, pandemics, governmental restraints, utility or communications failures, or any other causes that the affected party could not, with reasonable care, control or prevent. If such an event occurs, then where practicable, the affected party will use reasonable efforts to promptly resume its obligations under this Agreement upon cessation of the Force Majeure event.

GOVERNING LAW AND JURISDICTION

This Agreement shall be governed by and construed in accordance with the laws of the State of Texas, without regard to its conflict of law principles. Any dispute arising out of or in connection with this Agreement shall be subject to the exclusive jurisdiction of the state or federal courts located in the county where TBGI is headquartered.

I, , HEREBY DECLARE THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. FAILURE TO PROVIDE ACCURATE INFORMATION OR ANY WILLFUL MISREPRESENTATION RELEASES TBGI FROM ALL LIABILITY, WHILE ALL WAIVER OBLIGATIONS AND RELEASES OF THE CLIENT REMAIN IN FULL FORCE AND EFFECT.