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invisa-RED Consent/Waiver Form

Date of birth

Medical exclusions for usage of invisa-RED™ laser: Pregnancy, cancer, medically implanted devices, epilepsy, severe hypertension, cardiovascular disease, renal disease, immune diseases, and blood disorders/diseases.

By signing below, I understand and accept all of the that visual documentation (photo and/or video) is necessary for evaluation and marketing. I hereby release and hold harmless this clinic and invisa-RED™ Technology from any reasonable expectation of privacy or confidentiality associated with the images and/or videos specified above. I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type.

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