Medical Informed Consent, Assumption of Risk, and Release of Liability
Last Updated: October 2025
This Patient Consent Form (“Agreement”) establishes the terms under which LIVBETTER, LLC (“LIVBETTER,” “we,” “our,” or “us”) may provide medical and wellness services to the patient whose signature appears below (“Patient”). By signing, Patient acknowledges understanding of and agreement to all policies herein.
Patient provides informed consent for LIVBETTER to:
• Evaluate their health condition
• Recommend and administer treatment appropriate to their clinical needs
• Maintain medical records and documentation in accordance with HIPAA
Treatment may include, but is not limited to:
• Intravenous (IV) therapy
• Intramuscular (IM) injections
• Aesthetic procedures including neuromodulators, dermal fillers, biostimulators, microneedling, chemical peels, and related interventions
• Hormone replacement therapy
• Medical weight loss programs, including FDA-regulated medications when authorized
• Peptide therapy
• Wellness consultations and functional healthcare services
Patient understands that LIVBETTER may decline to provide services when deemed medically inappropriate or unsafe.
Patient agrees to provide complete and accurate medical history, including medications, supplements, allergies, chronic conditions, recent illnesses, prior procedures, and pregnancy status when applicable.
Patient acknowledges that withholding information may increase risk of complications and assumes responsibility for such outcomes.
All medical and aesthetic interventions involve inherent risks. Complications may occur including, but not limited to:
• Pain, tenderness, redness, swelling, bruising • Infection or inflammation
• Dizziness, fainting, or nausea
• Allergic or hypersensitivity reactions
• Scarring or pigment changes
• Unsatisfactory cosmetic results
• Failure to improve or worsening of a condition
• Need for additional or corrective treatment
• Rare but serious outcomes including vascular occlusion, nerve injury, or systemic medical events
Patient confirms they have been advised of potential risks and alternatives.
LIVBETTER does not guarantee or warrant specific treatment outcomes.
Results are dependent on patient compliance, physiology, health status, and other variables outside LIVBETTER’s control.
Photographs shown online or during consultations are for illustrative purposes only.
Patient understands they must follow all post-treatment instructions provided by LIVBETTER’s clinical team and accepts responsibility for any negative outcomes related to noncompliance.
By signing this Agreement, Patient acknowledges:
• Payments and deposits are non-refundable
• Deposits may be applied only as credit toward future services
• Cancellations or rescheduling must occur at least 24 hours in advance
• Failure to comply may result in forfeiture of deposit and/or a no-show fee
• Credits have no cash value and are non-transferable.
Patient grants or denies approval for clinical photography used solely for:
• Medical documentation
• Private progress comparison
Separate written authorization is required for any marketing or public use.
Patient will indicate authorization on the signature page.
Services may be provided to a minor only if:
• The minor’s parent or legal guardian signs this Agreement, and
• LIVBETTER’s clinical team approves such treatment
Parents/guardians assume all financial and legal responsibility on behalf of the minor.
Patient understands this facility is not an emergency care center.
In the event of severe or unexpected medical distress, Patient must seek emergency medical treatment by calling 911 or proceeding to the nearest emergency facility.
To the fullest extent permitted by law, Patient agrees to release, indemnify, and hold harmless:
LIVBETTER, LLC, its owners, licensed medical providers, employees, and contractors
from all liabilities, losses, costs, or claims arising from:
• Participation in medical or wellness treatments
• Complications or dissatisfaction with results
• Failure to follow pre- or post-treatment instructions
• Undisclosed medical conditions or contraindications
This release does not apply to gross negligence or misconduct prohibited by law.
By signing below, Patient affirms that they:
• Have read and fully understand this Agreement
• Have had the opportunity to ask questions
• Voluntarily consent to receive services from LIVBETTER
• Accept the stated risks and responsibilities
• Agree to all terms contained herein
Patient may withdraw consent at any time, except when such withdrawal would jeopardize their health or violate legal requirements.
