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PLEASE READ, UNDERSTAND, AND INITIAL THE FOLLOWING:

Please fill your name: *

Date of Birth: *(MM/DD/YYYY)

Please fill in Address: *

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Phone number: *

Email: *

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Always wear protective eyewear. Failure to wear protective eyewear may result in burns or long-term injury to the eyes.*

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You should prepare your skin for your session prior to your arrival. For optimal results, skin should be free of deodorant, make up, fragrances, oils, and lotions. Remove jewelry.*

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Certain Medications or cosmetics may increase your sensitivity to the red and/or LED light.*

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If you are pregnant or nursing we suggest consulting your physician before using LED light therapy.*

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For optimal results recommended therapy schedules are 3-4 days per week, for 4- 6 weeks. After the initial treatment schedule it is recommended to continue 1-2 days per week.*

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After treatments, sit up slowly to prevent dizziness. I understand that LED light therapy is not intended to take the place of medical care or medications.*

To my knowledge, I have no medical condition which would prohibit me from using LED light therapy. I acknowledge that the results of LED light therapy do vary, and that no guarantees of specific results are offered or implied. CoCo Glo Bar LLC will not refund or credit any amount of money because of a client’s unhappiness with their final results. I have been given adequate instructions for the proper use of the equipment, understand the risks involved, and use it at my own risk. I hereby agree to release the owners, operators and manufacturers from any damages that I might incur due to the use of this facility. I have reviewed and completely understand all of the information at www.cocoglobar.com, including this form.

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LED Facial Therapy Waiver