First Name Last Name Email Phone (###) ### #### Emergency Contact Waiver I understand that the services provided by Light Vibes, are drugless, non-invasive approaches to address physical, mental and emotional aspects. Our services can be used as a complimentary resource to prescribed medications, treatment plans or as independent form of restoration. I Agree Although published studies do indicate and support the value of these services, Light Vibes does not claim to be a replacement for medication or medical treatment of any kind. Nothing in this studio is intended to diagnose, treat, or cure any medical condition of any nature, and shall not be construed as medical advice, implied or otherwise. I confirm that no warranty, guarantee, or other assurance, has been made to me covering the results of any of the services, products or equipment offered for use by Light Vibes. Only my personal physician or another health professional can best advise me on matters of my health and use of Light Vibes services. I Agree I understand each of these modalities present their own contraindications and I am responsible for presenting any concerns to Light Vibes. Some of the contraindications include but are not limited to: Acute phases of any illness, infections accompanied by fever, acute active tuberculosis, cardiac insufficiency, COPD in third stage, bleeding, spitting of blood, contagious ailments, have use of an oxygen tank to aid breathing, alcohol or drug intoxication, unstable or uncontrolled hypertension/hypotension, seizures, and acute stages of respiratory diseases. Pregnant women should consult a physician prior to the use of any services at “Light Vibes. I understand that A PACEMAKER COULD HAVE SERIOUS REPERCUSSIONS IF COMING IN CONTACT WITH THE VIBROACOUSTIC OR INFRARED THERAPIES. I Agree In the event of an emergency, I authorize Light Vibes to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my immediate care and I agree that I will be responsible for payment of any and all medical services required. I Agree By typing my name below, I hereby release and hold harmless Light Vibes, its employees, agents and professional staff from any and all liability arising from or as a result of any services I will receive today and all future appointments. *You are consenting to the use of your electronic typed signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. Thank you!
