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invisa-RED Consent/Waiver Form

Date of birth

Medical exclusions for usage of invisa-REDâ„¢ 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-REDâ„¢ 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.

Contact Bali Holistic Wellness 

Bali Holistic Wellness Center B truncated logo .png

1 Commons Drive Bldg C #18

Londonderry NH 03053

info@balihw.com

1-877-603-BALI
 

Hours: By Appointment Only M: Closed T: 8:30 - 5:30 W: 8:30 - 5:30 TH: 8:30 - 8:00 F: 8:30 - 3:30 Limited Saturdays 10:00-2:00

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© 2025 Bali Holistic Wellness Center

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