GENERAL SERVICE WAIVER


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 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. 

I, HAVE READ THIS CONSENT AND CERTIFY THAT I UNDERSTAND ITS CONTENTS IN FULL.

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.

I, I HAVE READ THIS CONSENT AND CERTIFY THAT I UNDERSTAND ITS CONTENTS IN FULL.

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.

I, I HAVE READ THIS CONSENT AND CERTIFY THAT I UNDERSTAND ITS CONTENTS IN FULL.

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.

I, I HAVE READ THIS CONSENT AND CERTIFY THAT I UNDERSTAND ITS CONTENTS IN FULL.

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).

I, I HAVE READ THIS CONSENT AND CERTIFY THAT I UNDERSTAND ITS CONTENTS IN FULL.

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).

I, I HAVE READ THIS CONSENT AND CERTIFY THAT I UNDERSTAND ITS CONTENTS IN FULL.

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.

 

1, , have read these treatment descriptions and certify that I understand its contents in full. I have had enough time to consider the information and feel that I am sufficiently advised to consent to this procedure. I hereby give my consent to this procedure and proceed with booking an appointment with TBGI.


CONTRAINDICATIONS CONSENT

I, , agree to the following conditions


TREATMENT CONSENT

I, agree and consent to the following conditions:

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.

Leave this empty:

Signature arrow sign here

Signed by The Bello Group Inc
Signed On: February 16, 2026


Signature Certificate
Document name: GENERAL SERVICE WAIVER
lock iconUnique Document ID: 79c75bd0d9a7796e4cd5397c7f843250636e6660
Timestamp Audit
December 16, 2025 1:50 pm CSTGENERAL SERVICE WAIVER Uploaded by The Bello Group Inc - chiomafarmersbranch@gmail.com IP 97.134.209.83
December 16, 2025 2:10 pm CSTEbele Chioma - ebele.okocha@gmail.com added by CHIOMA Co. Concierge - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 72.110.53.134
December 16, 2025 3:35 pm CSTEbele Chioma - ebele.okocha@gmail.com added by CHIOMA Co. Concierge - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 72.110.53.134
December 19, 2025 10:46 am CSTEbele Chioma - ebele.okocha@gmail.com added by CHIOMA Co. Concierge - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 72.110.53.134
December 19, 2025 10:46 am CSTCHIOMA Farmers Branch - chiomafarmersbranch@gmail.com added by CHIOMA Co. Concierge - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 72.110.53.134
December 19, 2025 10:50 am CSTEbele Chioma - ebele.okocha@gmail.com added by CHIOMA Co. Concierge - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 72.110.53.134
December 19, 2025 10:50 am CSTCHIOMA Farmers Branch - chiomafarmersbranch@gmail.com added by CHIOMA Co. Concierge - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 72.110.53.134
February 16, 2026 9:03 am CSTEbele Chioma - ebele.okocha@gmail.com added by The Bello Group Inc - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 97.134.209.83
February 16, 2026 9:03 am CSTCHIOMA Farmers Branch - chiomafarmersbranch@gmail.com added by The Bello Group Inc - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 97.134.209.83
February 16, 2026 9:03 am CSTEbele Chioma - ebele.okocha@gmail.com added by The Bello Group Inc - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 97.134.209.83
February 16, 2026 9:03 am CSTCHIOMA Farmers Branch - chiomafarmersbranch@gmail.com added by The Bello Group Inc - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 97.134.209.83
February 16, 2026 9:08 am CSTEbele Chioma - ebele.okocha@gmail.com added by The Bello Group Inc - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 97.134.209.83
February 16, 2026 9:08 am CSTCHIOMA Farmers Branch - chiomafarmersbranch@gmail.com added by The Bello Group Inc - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 97.134.209.83
February 16, 2026 9:11 am CSTEbele Chioma - ebele.okocha@gmail.com added by The Bello Group Inc - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 97.134.209.83
February 16, 2026 9:11 am CSTCHIOMA Farmers Branch - chiomafarmersbranch@gmail.com added by The Bello Group Inc - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 97.134.209.83
February 16, 2026 9:14 am CSTEbele Chioma - ebele.okocha@gmail.com added by The Bello Group Inc - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 97.134.209.83
February 16, 2026 9:14 am CSTCHIOMA Farmers Branch - chiomafarmersbranch@gmail.com added by The Bello Group Inc - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 97.134.209.83
February 16, 2026 9:16 am CSTEbele Chioma - ebele.okocha@gmail.com added by The Bello Group Inc - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 97.134.209.83
February 16, 2026 9:16 am CSTCHIOMA Farmers Branch - chiomafarmersbranch@gmail.com added by The Bello Group Inc - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 97.134.209.83
February 16, 2026 9:18 am CSTEbele Chioma - ebele.okocha@gmail.com added by The Bello Group Inc - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 97.134.209.83
February 16, 2026 9:18 am CSTCHIOMA Farmers Branch - chiomafarmersbranch@gmail.com added by The Bello Group Inc - chiomafarmersbranch@gmail.com as a CC'd Recipient Ip: 97.134.209.83