GENERAL INFORMED CONSENT AND RELEASE

GENERAL INFORMED CONSENT AND RELEASE
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AI Wellness Center of Excellence Consents

GENERAL WELLNESS SERVICES INFORMED CONSENT & MODALITY ACKNOWLEDGMENT

AI Wellness
2080 Century Park E., Los Angeles, CA

SECTION I — GENERAL WELLNESS INFORMED CONSENT

I understand and acknowledge that AI Wellness is a wellness center, not a medical clinic or hospital.
All services offered are intended to support general wellness, relaxation, recovery, performance
optimization, and lifestyle enhancement and are not intended to diagnose, treat, cure, or prevent
any disease or medical condition.

I expressly understand and agree that:

  • AI Wellness does not provide medical diagnosis or medical treatment
  • No medical claims, guarantees, or promises of outcome are made
  • Any discussion of benefits is general, educational, and not individualized medical advice
  • Any data, scans, biometrics, or assessments are used for wellness and educational purposes only
  • AI Wellness is not a substitute for primary care, specialty care, mental health care, or emergency services
  • I am responsible for maintaining my own relationship with a licensed medical provider

Use of Artificial Intelligence (AI) Technologies

  • AI technologies are used solely for educational, informational, and recommendation-support purposes
  • AI outputs are not medical diagnoses, treatment plans, or clinical determinations
  • AI-generated insights are intended for wellness trend interpretation and lifestyle optimization only
  • Final decisions regarding participation in wellness services remain my responsibility

Research, Pilot Programs & Data Use

  • Participation in any pilot or research initiative is voluntary
  • Data collected may be used for research, analytics, program development, education, or publication
  • Personally identifiable information will remain confidential and handled in compliance with HIPAA and applicable privacy laws
  • Any data used externally will be de-identified unless separate authorization is provided

SECTION II — ASSUMPTION OF RISK & LIABILITY RELEASE

I understand that all wellness modalities involve inherent risks, which may include discomfort,
fatigue, soreness, skin irritation, lightheadedness, temporary symptom changes, or unpredictable
individual responses.

To the fullest extent permitted by California law, I knowingly and voluntarily assume all risks
associated with participation and release AI Wellness, its owners, providers, employees, and
affiliates from liability, except in cases of proven gross negligence or intentional misconduct.

SECTION III — WELLNESS MODALITIES ACCESS & ACKNOWLEDGMENT

I understand that the following wellness modalities may be available to me at AI Wellness.
I may choose which modalities to participate in and may decline or discontinue any modality at any time.

1. Photobiomodulation (PBM)
(SpaceTouch Capsule / Trifecta Red & Infrared Light)
Wellness purpose: relaxation, recovery support, circadian rhythm support, cellular energy support
Key contraindications: pregnancy, photosensitivity disorders, seizure disorders, active cancer,
photosensitizing medications, implanted electronic devices without clearance
2. InfraBaldan (Infrared-Assisted Cycling)
Wellness purpose: low-impact movement, circulation support, metabolic activity, relaxation
Key contraindications: severe cardiovascular instability, heat intolerance, uncontrolled dizziness,
recent surgery without clearance
3. Low Level Laser Therapy (LLLT)
Wellness purpose: recovery support, tissue relaxation, wellness-based light therapy
Key contraindications: malignancy in treatment area, pregnancy over abdomen, photosensitivity,
seizure disorders
4. Shockwave Therapy
Wellness purpose: musculoskeletal wellness support, circulation, recovery
Key contraindications: bleeding disorders, anticoagulant use, pregnancy, malignancy,
acute inflammation, implanted devices in treatment area
5. RASHA LTD & Jere Rivera-Dugenio LTD WAIVER AND RELEASE OF LIABILITY
5.1 Release
The undersigned (“Releasor”) acknowledges that his/her participation in or use of RASHA LTD and/or Jere Rivera-Dugenio LTD’s (“JRD”) technologies, programs, equipment, or facilities may involve physical, mental, or emotional risk, including potential injury.
Releasor agrees, on behalf of himself/herself and his/her heirs, executors, administrators, and assigns, to fully and forever waive, release, indemnify, and hold harmless JRD, its affiliates, and all respective officers, trustees, employees, volunteers, agents, landlords, successors, and assigns (collectively, the “Releasees”) from any and all claims, demands, damages, rights of action, or causes of action—present or future, known or unknown, anticipated or unanticipated—arising from or related to participation in or use of JRD’s services, equipment, or facilities.
This includes, without limitation, any personal, bodily, mental, or emotional injury; economic loss; or harm to Releasor, Releasor’s spouse, guests, unborn child, or relatives. Releasor further releases the Releasees from any liability for loss, theft, or damage to personal property.
Releasor affirms that he/she has read and understands this waiver and knowingly assumes all risks associated with participation.
5.2 Knowing and Voluntary Execution
I acknowledge that I have carefully read this Waiver and Release of Liability, fully understand its contents, and voluntarily agree to its terms.
I understand that this is a legal agreement between myself and JRD and/or its affiliated organizations, and I am signing it of my own free will.
6. PEMF (Pulsed Electromagnetic Field Therapy)
Wellness purpose: recovery support, circulation, relaxation
Key contraindications: pacemakers or implanted electronic devices, pregnancy, seizure disorders
7. Frequency Treatments (Equiscope)
Wellness purpose: neuromuscular wellness, relaxation, movement support
Key contraindications: pacemakers, implanted electronic devices, pregnancy, seizure disorders
8. Radiofrequency Therapy (INDIBA)
Wellness purpose: tissue warming, circulation support, relaxation, recovery
Key contraindications: implanted electronic devices, pregnancy, active cancer,
open wounds, metal implants in treatment area
9. EMS (Electrical Muscle Stimulation)
Wellness purpose: muscle engagement, circulation, neuromuscular wellness
Key contraindications: pacemakers, seizure disorders, pregnancy, thrombosis, acute injury
10. Far Infrared Sauna (Relax Sauna)
Wellness purpose: relaxation, circulation, sweating, stress relief
Key contraindications: heat intolerance, dehydration, pregnancy,
uncontrolled blood pressure, cardiovascular instability
11. NanoVi
Wellness purpose: relaxation, stress support, wellness recovery
Key contraindications: none commonly reported; discontinue if dizziness or discomfort occurs
12. Avacen
Wellness purpose: localized circulation support, relaxation, recovery
Key contraindications: severe vascular disease, heat intolerance, skin sensitivity, open wounds
13. Xometrics
Wellness purpose: movement awareness, strength engagement, performance assessment
Key contraindications: acute injury, uncontrolled pain, recent surgery without clearance
14. ExoPod (Multimodal Wellness Pod Experience)
Wellness purpose: relaxation, stress reduction, nervous system regulation,
circulation support, recovery support through a combined experience that may include
red/infrared light, heat, vibration, sound, or ambient wellness elements
Key contraindications: pregnancy, heat intolerance, claustrophobia, seizure disorders,
implanted electronic devices, cardiovascular instability, fever, fainting history

SECTION IV — EMERGENCY & MEDICAL CARE DISCLAIMER

I understand that AI Wellness does not provide emergency or urgent medical care.
If I experience chest pain, shortness of breath, loss of consciousness, or other urgent symptoms,
I am responsible for seeking immediate medical attention (911 / Emergency Department).

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