Name *

First Name

Last Name

Phone

(###)

###

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Recovery Room Polices *

Please read and agree to all below:

I agree to come with a clean face and skin free of body oils for each session (these oils can disrupt the efficacy of the light and damage the bed).

I agree to be in compliance with all health and safety policies as outlined at barrewest.com/policies

I agree not apply products that should not be exposed to mild warmth prior to my Recovery Room treatment.

I agree to cancel appointments a minimum of 24 hours prior to avoid a late cancellation penalty. Appointments cancelled less that 24 hours in advance are subject to a $45 late fee or deduction of 1 session).

Medical Exclusions *

1. The use of certain antibiotics that are not recommended for use while also being exposed to light and warmth. 2. Cancer and other autoimmune diseases that can be exacerbated by light and warmth. 3. Skin conditions such as lesions, skin cancer, melasma, or hyper pigmentation, and pregnancy.

I agree that the above conditions do not appy OR I have received approval from my physician to proceed with Red Light Therapy Treatments.

Electronic Signiature *

I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY WAIVING SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE BARRE AND THE RELEASEES.