Terms and Conditions for PrimeHealth Online
Prime Health Medical Aesthetic Clinic Consent Form Agreement
1035 Sterling Rd, Ste 104, Herndon, VA
This consent form agreement ("Agreement") is made and entered into by the undersigned patient ("Patient") and Prime Health Aesthetic Clinic ("Clinic"), located at 1035 Sterling Rd, Ste 104, Herndon, VA.
**1. Scope of Services**
The Patient consents to receive one or more of the following treatments provided by the Clinic:
- Botox injections
- Dermal fillers
- RF microneedling
- High-Intensity Focused Ultrasound (HIFU)
- Laser treatments, including Hair Removal, Fractional CO2, Pico Laser
- Fat loss injections
- Other injection-based treatments & any other treatments.
- Hair growth and hair loss treatments
**2. Acknowledgment of Risks and Side Effects**
The Patient acknowledges and understands that there are inherent risks and potential side effects associated with the treatments listed above. These may include, but are not limited to:
**Common Side Effects:**
- Redness
- Swelling
- Bruising
- Pain at the treatment site
- Itching
- Tenderness
- Temporary discomfort
**Moderate Side Effects:**
- Infection
- Allergic reactions
- Pigmentation changes (hyperpigmentation or hypopigmentation)
- Scarring
- Dryness
- Skin irritation
**Serious Side Effects:**
- Burns
- Blistering
- Hair loss
- Nerve damage
- Vascular occlusion (blockage of blood vessels)
- Blindness (in rare cases, particularly with injections near the eyes)
- Severe allergic reactions (anaphylaxis)
- Permanent scarring or disfigurement
The Patient acknowledges that the list of potential side effects provided above is not exhaustive and that other unforeseen risks and side effects may occur.
**3. No Guarantee of Results**
The Clinic does not guarantee specific results from any treatments. The Patient understands and accepts that the outcomes of aesthetic treatments can vary significantly among individuals and that there is no assurance of a particular result.
**4. Release of Liability**
By signing this Agreement, the Patient agrees to release, waive, and discharge Prime Health Aesthetic Clinic, its employees, doctors, managers, owners, and any individuals related to the Clinic from any and all liability, claims, demands, actions, or causes of action arising out of or related to any injury, including death, loss, or damage that may be sustained by the Patient as a result of receiving treatments at the Clinic.
**5. Indemnification**
The Patient agrees to indemnify and hold harmless Prime Health Aesthetic Clinic, its employees, doctors, managers, owners, and any individuals related to the Clinic from any and all claims, losses, damages, liabilities, costs, or expenses (including attorney's fees) that may arise from or be related to the Patient's actions or inactions, including but not limited to the Patient's breach of this Agreement.
Furthermore, by signing this Agreement, the Patient expressly waives and relinquishes the right to file a lawsuit or take any legal action against Prime Health Aesthetic Clinic, its employees, doctors, managers, owners, or any individuals related to the Clinic for any reason. This includes, but is not limited to, any injury, side effect, dissatisfaction with the results of the treatments, or any other claim that may arise from the treatments provided by the Clinic.
This waiver is comprehensive and applies to all possible claims, whether known or unknown at the time of signing this Agreement. The Patient understands and accepts that by signing this Agreement, they are giving up the right to seek legal recourse or compensation through the court system for any issue related to the treatments received at Prime Health Aesthetic Clinic.
The Patient acknowledges that this waiver of legal action is a condition for receiving treatments at the Clinic. The Patient further confirms that they have had the opportunity to ask questions about this waiver, seek independent legal advice if desired, and fully understand the implications of signing this Agreement.
**6. Use of Photographs and Videos**
The Patient consents to the taking of photographs and videos before, during, and after the treatments for the purpose of documenting progress and results. The Patient further consents to the use of these photographs and videos by the Clinic for any lawful purpose, including but not limited to advertising, marketing, educational, and promotional purposes, without the need for further permission from the Patient.
The Patient understands and agrees that they will not receive any compensation for the use of these photographs and videos and that the Clinic will not be required to pay any royalties, licensing fees, or any other fees associated with the use of the images. This consent is granted indefinitely and applies to all photographs and videos taken in the course of treatments at the Clinic from the date of signing this Agreement.
**7. Binding Nature of Agreement**
This Agreement shall apply to all services provided by the Clinic from the date of signing and shall continue to apply to all future services provided to the Patient by the Clinic.
**8. Governing Law and Jurisdiction**
This Agreement shall be governed by and construed in accordance with the laws of the Commonwealth of Virginia. Any disputes arising out of or relating to this Agreement shall be resolved in the state or federal courts located in Fairfax County, Virginia.
**9. Entire Agreement**
This Agreement constitutes the entire understanding and agreement between the Patient and the Clinic and supersedes all prior and contemporaneous agreements, representations, and understandings, whether written or oral, with respect to the subject matter hereof.
**10. Severability**
If any provision of this Agreement is held to be invalid, illegal, or unenforceable, the remaining provisions shall continue in full force and effect.
**11. Patient's Acknowledgment**
The Patient acknowledges that they have read and fully understand the terms and conditions of this Agreement, have been given the opportunity to ask questions, and have received satisfactory answers regarding the treatments, risks, and side effects.
**12. Voluntary Consent**
The Patient voluntarily consents to receive the treatments listed above and agrees to be bound by the terms and conditions of this Agreement.
*Last updated: 09/15/2023
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