AI Wellness Center of Excellence

General Medical & Cosmetic Informed Consent, Assumption of Risk & Financial Release

1. Consent to Medical & Cosmetic Services

I hereby voluntarily consent and authorize AI Wellness Center of Excellence (“AI Wellness”) to provide medical and cosmetic evaluations, consultations, procedures, and treatments to my face and/or body, as discussed, recommended, and/or requested by me.

This consent applies to services authorized verbally or in writing during consultations, evaluations, follow-up visits, and procedures, and extends to future medical or cosmetic treatments of a similar nature unless revoked by me in writing.

I understand that I may refuse or discontinue treatment at any time.

2. Medical / Cosmetic Consultation Scope

I understand and acknowledge that:

• Consultations at AI Wellness that involve diagnosis, medical judgment, or treatment planning are medical or cosmetic consultations only.
• Such consultations are provided by licensed medical providers within their scope of practice.
• This consent applies only to medical and cosmetic services and does not apply to separate wellness services, which are governed by a different consent.

3. Information & Opportunity for Questions

I acknowledge that I have reviewed educational materials and/or participated in a medical or cosmetic consultation regarding the procedures or treatments I elect to receive.

I understand the nature of the procedures, expected course of care, alternatives, potential risks and side effects, and pre- and post-treatment instructions. I confirm that I have had the opportunity to ask questions and that all questions have been answered to my satisfaction.

4. Results Vary – No Guarantees

I expressly understand and agree that:

• Results vary from patient to patient.
• Different areas of my face or body may respond differently.
• No specific outcome can be guaranteed.
• I am paying for professional medical services and treatment, not for any guaranteed result.
• No warranties, promises, or assurances regarding outcome have been made.

5. Multiple Treatments & Maintenance

I understand that:

• Many medical and cosmetic treatments are cumulative in nature.
• Multiple treatment sessions may be required to achieve optimal results.
• Combination therapies and/or maintenance treatments may be necessary.
• Results may change over time due to aging, genetics, hormonal factors, lifestyle, or environmental exposure.
• Even successful treatment does not prevent future changes or recurrence.

6. Risks, Side Effects & Unpredictable Responses

I understand that all medical and cosmetic procedures involve inherent risks, which may include but are not limited to:

• Redness, swelling, bruising, or tenderness
• Itching, irritation, crusting, or peeling
• Infection or pigmentation changes
• Temporary dissatisfaction with appearance
• Rare allergic or hypersensitivity reactions
• Unpredictable or uncommon side effects

While most side effects are temporary, no outcome can be guaranteed.

7. Patient Responsibility & Duty to Communicate

I acknowledge and agree that:

• I am responsible for providing complete and accurate medical history, medications, allergies, and health information.
• I must promptly notify AI Wellness of any complications, concerns, adverse reactions, or unexpected outcomes.
• I agree to allow AI Wellness the opportunity to evaluate, manage, or participate in my care before seeking outside intervention when reasonably possible.
• Failure to notify AI Wellness or follow recommended follow-up care may negatively impact outcomes and releases AI Wellness from responsibility for resulting complications.

8. Financial Responsibility & No Refunds for Dissatisfaction

I expressly understand and agree that:

• All payments made to AI Wellness are for professional services rendered, including provider time, expertise, materials, and performance of treatment.
• Payment is not contingent upon achieving any specific medical, cosmetic, or subjective result.
• Individual satisfaction is subjective and varies by patient.
• Patient-determined dissatisfaction does not constitute improper care, negligence, or failure of service.
• No refunds, credits, or chargebacks will be issued for services performed based solely on dissatisfaction with results.
• Slower-than-expected improvement or unmet personal expectations do not entitle me to a refund.
• This policy applies to all medical and cosmetic services, except as otherwise required by law.

9. Provider Authorization

I understand that medical or cosmetic services may be provided by qualified and licensed professionals including MDs/DOs, NPs, PAs, RNs, or appropriately trained clinical staff acting within their permitted scope of practice and under clinic protocols.

10. Photographs & Medical Records

I consent to clinical photographs for documentation, treatment planning, and education.

Medical records will be maintained and released in accordance with HIPAA and California law upon written request. No identifiable images will be used publicly without separate written authorization.

11. Appointments, Cancellations & Fees

I understand that:

• Appointments require at least 24 hours’ notice to cancel or reschedule.
• Late cancellations or no-shows may result in fees.
• Prepaid services and packages are subject to clinic policies.
• Discounted packages are prorated at standard (non-package) rates when applicable.

12. Assumption of Risk & Release of Liability

To the fullest extent permitted by California law, I voluntarily assume all known and unknown risks associated with medical and cosmetic treatment and release and hold harmless AI Wellness, its owners, providers, staff, and affiliates from liability for dissatisfaction, complications, or outcomes, except in cases of proven gross negligence or willful misconduct.

13. Governing Law & Severability

This consent shall be governed by the laws of the State of California. If any provision is held invalid, the remainder shall remain in full force and effect.