Waiver Form Identification of Parties
"I," the undersigned (referred to hereafter as the “Patient”), agree to the following terms and conditions as outlined in this waiver by the service provider Fadeaway Vancouver Laser Tattoo Removal.
1. Procedure Description
Laser tattoo removal involves the use of specialized lasers to break down tattoo ink particles in the skin, which are then naturally removed by the body’s immune system.
2. Risks and Potential Complications
Patient understands and acknowledges the following:
- i. Potential side effects and complications: The procedure may cause side effects and complications, including but not limited to pain, redness, swelling, blistering, scarring, infection, changes in skin pigmentation, and incomplete removal of the tattoo.
- ii. Pre-Existing Scarring Due to Tattooing: The process of getting a tattoo can sometimes result in scarring or changes in the skin's texture. These pre-existing scars may not be visible or noticeable until after the laser tattoo removal process begins. Patient understands that laser tattoo removal may not fully eliminate these scars and, in some cases, may make them more apparent. The presence of pre-existing scars may affect the outcome of the tattoo removal process and that additional treatments or care may be necessary to address these issues.
- iii. Eye Protection: Exposure of eyes to laser light could cause permanent vision loss. Patient must keep the eye protection goggles on at all times.
- iv. Allergic Reactions: The laser breaks down ink into small particles that are flushed out by your immune system. The ink pigments can induce mild to severe allergic reactions that can occur with each successive treatment. This may occur if you are allergic to the ink in your tattoo, topical numbing cream (Lidocaine) applied before the procedure, or to topical healing agents (Neosporin, Aquaphor, etc.) applied after the laser procedure. Some of the reactions could be red bumps, hives, severe itching at the site, and unusual amounts of edema in the treated area. Should any of these reactions occur, please seek medical treatment from a licensed physician immediately and then inform us.
- v. Pregnancy: It is generally advised to avoid laser treatments during pregnancy due to potential risks to the developing fetus. The safety of laser tattoo removal during pregnancy has not been established, and potential side effects could include stress, pain, or infection, which may adversely affect pregnancy.
- vi. Breastfeeding: The laser treatment process breaks down tattoo ink into smaller particles, which may be absorbed and excreted by the body. While it is not confirmed whether these particles can enter breast milk, individuals who are breastfeeding should exercise caution.
3. No Guarantee
Patient acknowledges that multiple treatment sessions may be necessary to achieve desired results, that color can be especially difficult to fully remove, and that complete removal of the tattoo is in no way guaranteed.
4. Full Removal Package Policy
The full removal package allows patients to receive unlimited sessions until the treated tattoo is removed to the fullest extent possible. However, it is important to understand that some tattoos may not be fully removable due to factors such as the individual’s healing process, the area where the tattoo is located, the color, type and/or age of the ink, any scarring resulting from the original tattoo process or its aftercare and healing process, as well as any scarring resulting from the aftercare and healing process of tattoo removal.
Our clinic tracks the progress of your tattoo removal by comparing images from each session. Once we determine that there is no further visible breakdown of the tattoo, based on these comparisons, the removal process will be considered complete. The decision on whether additional sessions will be beneficial will be made by our technicians based on the image comparisons and overall progress.
By agreeing to this policy, the Patient acknowledges that even with unlimited sessions, complete removal cannot be guaranteed and that the decision to conclude treatment will be made by the clinic when no further progress is observed.
5. Pre-Procedure and Post-Procedure Instructions
Patient has been provided with and understands the pre-procedure and post-procedure instructions. Patient agrees to follow these instructions carefully to minimize the risk of complications and enhance the effectiveness of the treatment.
6. Aftercare
Patient understands that compliance with the Pre-Procedure and Post-Procedure Instructions is crucial for healing, prevention of scarring, hyperpigmentation, and hypopigmentation. The patient further agrees and acknowledges that proper aftercare is just as important as the procedure itself in achieving the best possible outcome and reducing the risk of complications.
7. Medical History and Ongoing Updates
Patient has been provided with a comprehensive medical questionnaire and has disclosed all relevant medical history, including any skin conditions, medications, and allergies. Patient understands that withholding medical information may increase the risk of complications. The patient acknowledges that, as part of the ongoing treatment process, they will be asked to complete a brief update form before each session to confirm if any changes have occurred in their medical history, medications, or overall health. The patient agrees to this process and understands that accurate and up-to-date information is crucial for their safety and the effectiveness of the treatment.
8. Medical Disclaimer
The patient acknowledges that the staff and practitioners at Fadeaway Vancouver Laser Tattoo Removal are not licensed physicians and have not represented themselves as such. We do not provide medical diagnoses, treatments, or advice. The patient has been informed that it is their responsibility to seek medical advice from a licensed healthcare provider prior to undergoing any laser tattoo removal procedures. Any guidance or information provided by our clinic is for informational purposes only and should not be considered a substitute for professional medical advice.
9. Consent to Treatment
Patient consents to the administration of laser tattoo removal treatments by the technician. I acknowledge that I have had the opportunity to ask questions and that all of my questions have been answered to my satisfaction.
10. Certification of Sobriety
Patient certifies that they are not under the influence of any illicit drugs, alcohol, or any substances that may impair judgment or ability to provide informed consent. Patient understands that being under the influence of such substances may increase the risks associated with laser tattoo removal, and confirms that they are sober and capable of making decisions regarding this procedure.
11. Image & Video Consent
Patient agrees to the photographing and/or video recording of their tattoo and procedure and releases all rights to Fadeaway Vancouver Tattoo Removal to use at their discretion. We use these to document your treatment progress. We may also use these photographs for scientific and/or illustrative purposes. Patient understands that they will not be identifiable in these photos and/or videos (except for the nature of the tattoo itself).
12. Reviews and Feedback
By accepting these terms, the patient agrees to provide honest and accurate feedback regarding the services rendered. The undersigned shall not post or cause to be posted any false, misleading, or malicious reviews about Fadeaway Vancouver or its services. In the event of dissatisfaction or concerns, the Patient agrees to notify Fadeaway Vancouver and provide a reasonable opportunity to address and rectify the issue before making any public statements, reviews, or comments that could potentially damage the Fadeaway Vancouver reputation.
13. Waiver of Liability
Patient hereby releases, waives, and discharges Fadeaway Vancouver Tattoo Removal and its employees, agents, and representatives from any and all claims, demands, damages, actions, or causes of action arising out of or connected with the laser tattoo removal procedure, including but not limited to any injury, damage, or loss that the patient may incur.
14. Indemnification
Patient agrees to indemnify and hold harmless Fadeaway Vancouver Tattoo Removal from any and all liabilities, claims, or causes of action for injuries or damages arising out of or related to the laser tattoo removal treatments.
15. Confidentiality
Patient understands that their personal information, medical history, and any other sensitive information disclosed during the consultation or treatment process will be kept confidential and only used for the purposes of providing the service. Fadeaway Vancouver Tattoo Removal adheres to privacy laws and regulations, ensuring that my information will not be disclosed to third parties without my explicit consent, except where required by law.
16. Emergency Contact
Patient has provided the contact information of an emergency contact person in case of any adverse reactions or emergencies during or after the procedure. This person can be reached at the contact information provided.
17. Payment and Refund Policy
Patient understands that all payments for the laser tattoo removal services must be made in full prior to each treatment session, unless otherwise agreed upon. Patient acknowledges that the payment is non-refundable, except in cases where Fadeaway Vancouver Tattoo Removal cancels a session without rescheduling. Patient agrees to provide at least 48 hours' notice for cancellations or rescheduling; failure to do so may result in a cancellation fee. Repeated violations of the cancellation policy may result in the suspension of services without a refund and is at the total discretion of Fadeaway Vancouver Tattoo Removal.
18. Consent to Receive Communications
Patient consents to receive communications from Fadeaway Vancouver Tattoo Removal via email, phone, or text messages for appointment reminders, follow-ups, promotional offers, and other relevant information. Patient understands that they can opt out of these communications at any time by notifying the company.
19. No Unauthorized Recordings
Patient acknowledges that they are not permitted to record, photograph, or video the procedure or any part of the treatment process without the explicit consent of Fadeaway Vancouver Tattoo Removal and its staff. Unauthorized recordings may violate privacy laws and could result in legal action.
20. Non-Transferability of Services
Patient understands that the services provided by Fadeaway Vancouver Tattoo Removal are non-transferable. Patient may not transfer their rights or obligations under this agreement to any other individual without the express written consent of the company.
21. Zero Tolerance for Abuse
We maintain a zero-tolerance policy for any form of verbal or physical abuse directed toward our staff, practitioners, other clients, as well as anyone working in or visiting the building. Any such behavior will result in the immediate cancellation of future appointments, forfeiture of any remaining balances or sessions, and, in severe cases, may include a permanent ban from our premises. This may involve issuing a formal No Trespass Order, legally prohibiting the individual from entering the property, and any violation of this order will result in further legal action.
22. Governing Law and Jurisdiction
This agreement shall be governed by and construed in accordance with the laws of the province of British Columbia. Any disputes arising out of or in connection with this agreement shall be subject to the exclusive jurisdiction of the courts of Vancouver, British Columbia, Canada.
23. Severability
If any provision of this agreement is found to be invalid or unenforceable by a court of competent jurisdiction, the remaining provisions shall continue in full force and effect. The invalid or unenforceable provision shall be modified to the minimum extent necessary to render it valid and enforceable.
24. Agreement to Arbitration
In the event of any dispute, controversy, or claim arising out of or relating to the services provided by Fadeaway Vancouver Tattoo Removal, or the interpretation, breach, or enforcement of this agreement, the parties agree to resolve such matters through binding arbitration. The arbitration will be conducted in accordance with the rules of the ADR Institute of Canada (ADRIC) or a similar organization as agreed upon by both parties and take place in Vancouver, BC.
The decision rendered by the arbitrator(s) will be final and binding on all parties. Each party will bear its own costs and expenses associated with the arbitration, including legal fees, unless otherwise determined by the arbitrator(s).
By agreeing to this clause, both parties waive their right to a trial in a court of law or to participate in a class-action lawsuit. The undersigned understands and accepts that this arbitration agreement constitutes a waiver of the right to litigate disputes in court.
25. Legal Age Requirement
The patient confirms that they are at least 18 years of age, the legal age required for this procedure. If the patient is under the age of 18, they have brought a parent or legal guardian to provide consent and authorize the procedure on their behalf. The guardian acknowledges that they have read and understood the Informed Consent & Release of Liability Agreement and agree to all its terms.
26. Acknowledgment of Understanding & Agreement
I, the undersigned Patient, acknowledge that I have read the Informed Consent & Release Of Liability Agreement, fully understand its terms, and acknowledge that I am signing it freely and voluntarily. I understand that I am giving up substantial rights, including the right to take legal action.