Bellanina Facelift Massage Informed Consent & Liability Waiver

1. Acknowledgement of Service

I understand that Bellanina Facelift Massage is a manual massage technique that focuses on the face, neck, and related areas through massage, acupressure, lymphatic movement, and specialized contouring strokes. I understand that this service is holistic and relaxation-oriented, and is not a medical, cosmetic surgical, or clinical treatment.

2. No Guarantee of Results

I understand that results vary from person to person and are not guaranteed. I acknowledge that expected outcomes, including changes to muscle tone, skin appearance, fine lines, or facial appearance, are subjective and may differ based on individual factors such as age, skin condition, lifestyle, and frequency of treatments.

3. Medical and Health Disclosure

I confirm that I have fully disclosed all relevant medical history and current health conditions. I understand that I should consult a licensed medical or dermatological professional before receiving this service if I have:

• Serious skin conditions or inflammation
• Facial surgery or recent facial trauma
• Neurological conditions
• Severe circulatory disorders
• Autoimmune or connective tissue disorders
• Cancer or treatments that impact skin or tissue healing
• Pregnancy or breastfeeding

I understand that Sierra’s Integrative BodyWorx does not diagnose or treat diseases and that this service is not intended to treat medical conditions.

4. Possible Sensations and Side Effects

I understand that possible sensations may include:

• Temporary redness or warmth
• Mild tenderness
• Increased local circulation
• Emotional release or relaxation response

I acknowledge that these effects are typically temporary and are part of the body’s natural response to massage.

5. Release of Liability

I voluntarily consent to receive Bellanina Facelift Massage at Sierra’s Integrative BodyWorx. I release and hold harmless Sierra Cooper and Sierra’s Integrative BodyWorx from any liability, claims, damages, or actions arising from my participation in this service, except in cases of gross negligence.

6. Consent to Treatment

By signing below, I confirm that I have read, understand, and agree to this waiver and consent. I understand the nature of the service and choose to receive it at my own risk.

I knowingly, voluntarily, and intelligently request and consent to receive the Bellanina Face Massage from Sierra’s Bodyworx (“Provider”). I acknowledge and understand that the Bellanina Face Massage is a non-medical facial massage and cosmetic wellness service intended to promote relaxation, lymphatic stimulation, and aesthetic appearance. The service is not a medical procedure and does not constitute medical treatment, diagnosis, or advice. No representations, warranties, or guarantees have been made regarding results, and individual results may vary.

I acknowledge that participation in facial massage services involves inherent and potential risks, whether known or unknown, including but not limited to temporary redness, sensitivity, flushing, swelling, tenderness, light bruising, muscle soreness, sinus drainage, headache, or temporary skin irritation. I expressly assume all risks associated with the Bellanina Face Massage, whether foreseeable or unforeseeable, and accept full responsibility for any outcomes or reactions.

I represent and warrant that I have fully disclosed all relevant medical history and conditions, including but not limited to recent facial surgery or cosmetic procedures; injectable fillers or neurotoxins; active acne, rosacea, dermatitis, or skin infections; open wounds or lesions; blood clotting disorders; use of blood-thinning medications; neurological or vascular conditions; or any other condition that may be affected by facial massage. I acknowledge that the Provider relies on the accuracy of this information and that any failure to disclose or misrepresentation of medical information releases the Provider from any and all liability for resulting injury or damages.

To the fullest extent permitted by law, I hereby knowingly and expressly release, waive, acquit, satisfy, and forever discharge Sierra’s Bodyworx, its owner, employees, independent contractors, representatives, successors, and assigns from any and all claims, demands, causes of action, damages, losses, costs, or liabilities of any kind, whether in law or equity, whether known or unknown, suspected or unsuspected, arising out of or related in any way to the Bellanina Face Massage services, including claims arising from the ordinary negligence of the Provider. This release is intended to be as broad and inclusive as permitted under Florida law and shall be binding upon my heirs, executors, administrators, successors, and assigns.

I acknowledge that Sierra’s Bodyworx operates in accordance with applicable provisions of Florida Statutes Chapter 480 (Massage Practice Act) and that Bellanina Face Massage services are provided strictly within the scope of licensed massage therapy and non-medical cosmetic bodywork services. I understand that the Provider does not render medical opinions or advice and that I have been advised to consult with a licensed healthcare professional regarding any medical or dermatological concerns prior to receiving services.

Privacy and Confidentiality Notice: Sierra’s Bodyworx maintains the confidentiality of client personal and health-related information in accordance with applicable Florida law, including but not limited to Florida Statutes §§456.057 and 501.171, as applicable. Client information is collected and used solely for treatment documentation, scheduling, billing, and lawful business operations. Records are maintained in a secure manner and disclosed only with written authorization or as required by law. Sierra’s Bodyworx is not a covered entity under the Health Insurance Portability and Accountability Act (HIPAA); however, it implements HIPAA-consistent administrative, technical, and physical safeguards to protect client information.

By receiving Bellanina Face Massage services, I acknowledge that I have read and fully understand this document, that I understand I am waiving substantial legal rights, including the right to sue, and that I voluntarily agree to be bound by its terms under the laws of the State of Florida.

1. Description of Service

I understand that Lypossage™ is a non-invasive manual body contouring and lymphatic massage technique designed to support circulation, lymphatic flow, and the appearance of skin tone and texture. I understand that this service is cosmetic and wellness-based in nature.

2. No Medical Claims

I understand that Lypossage™ is not a medical treatment and is not intended to diagnose, treat, cure, or prevent any disease or medical condition. I acknowledge that results vary from person to person and are not guaranteed.

3. Possible Effects

I understand that temporary side effects may include:

• Mild soreness
• Redness
• Bruising
• Increased urination
• Temporary tenderness

I understand that these effects are typically short-term.

4. Medical Disclosure

I certify that I have disclosed all relevant health conditions. I understand I should consult my physician prior to treatment if I have:

• Circulatory disorders
• Lymphatic disorders
• Blood clotting issues
• Active infections
• Cancer or undergoing cancer treatment
• Recent surgery
• Pregnancy
• Cardiovascular conditions

I confirm that I have disclosed any medications that may affect circulation or bruising.

5. Release of Liability

I voluntarily consent to receive Lypossage™ services at Sierra’s Integrative BodyWorx. I release and hold harmless Sierra Cooper and Sierra’s Integrative BodyWorx from any liability, claims, damages, or actions arising from my participation in this service, except in cases of gross negligence.

6. Results Acknowledgment

I understand that results vary and depend on individual factors including lifestyle, hydration, diet, and frequency of sessions. No specific results have been promised or guaranteed.

Lypossage Procedure Disclaimer

Disclaimer:
Lypossage is a non-invasive, manual body contouring and lymphatic drainage massage technique designed to support circulation, lymphatic flow, and the appearance of skin texture and tone. Results from Lypossage treatments may vary by individual and are not guaranteed. Lypossage is not a medical weight-loss procedure and should not be considered a substitute for a healthy diet, exercise, or medical treatment. Individual experiences with dimension changes or visual improvement in cellulite appearance differ, and multiple sessions may be recommended.

Lypossage at Sierra’s Integrative BodyWorx is provided by trained practitioners and is intended to promote relaxation and therapeutic body contouring effects. Results and benefits are subjective and may not occur for everyone. Any statements regarding inch loss, improved appearance, or other outcomes are based on general industry reports and are not guaranteed claims of specific results. Before receiving Lypossage, clients should consult with their healthcare provider if they have any medical conditions, skin sensitivities, circulatory or lymphatic disorders, are pregnant, or are taking medications that affect blood flow or tissue healing.