General Aesthetic Informed Consent
& Liability Acknowledgment

Purpose of This Consent

This document serves as a general informed consent for aesthetic, cosmetic, and skin-related services provided at Navara Health, PLLC, whether performed by a licensed medical provider, registered nurse, licensed esthetician, or trained clinical staff working under appropriate supervision and within their scope of practice.

By signing this form, I acknowledge that I understand the nature of aesthetic treatments, the potential risks and limitations, and my responsibilities as a client of Navara Health.

Consent to Aesthetic Services

I voluntarily consent to receive aesthetic and cosmetic services, which may include but are not limited to:

I understand that:

• The specific treatment(s) performed will be discussed prior to service
• Treatment recommendations are individualized based on my skin type, goals, history, and current condition
• I may decline or discontinue any treatment at any time
• The provider may decline to perform a requested service if it is clinically inappropriate

Acknowledgment of Risks & Limitations

All aesthetic treatments carry inherent risks, even when performed properly and with appropriate precautions.

I understand that:

• Individual results vary based on skin type, age, genetics, lifestyle, and adherence to aftercare
• No guarantees, promises, or warranties are made regarding outcomes, longevity, or satisfaction
• Some treatments may worsen underlying conditions if not disclosed in advance
• Unforeseen complications may occur, even with appropriate screening and technique
• Complications may require additional treatment, prescription medications, or specialty referral at additional cost to me

Client Disclosure Responsibilities

I certify that I have fully disclosed, and will continue to disclose at each visit, all relevant information including but not limited to:

• Medical conditions or diagnoses (cardiac, autoimmune, bleeding disorders, hormone-sensitive cancers, etc.)
• Skin conditions, sensitivities, or prior reactions to aesthetic treatments
• Current and recent medications (prescription, over-the-counter, supplements, herbals)
• Use of isotretinoin (Accutane) within the past 6 months
• Current or recent use of anticoagulants or blood thinners
• Allergies (topical products, anesthetics, latex, adhesives, preservatives)
• Pregnancy, possible pregnancy, or breastfeeding
• Recent aesthetic procedures, injectables, peels, lasers, or microneedling
• Recent surgeries, dental procedures, or vaccinations
• History of cold sores, keloids, hypertrophic scarring, melasma, or post-inflammatory hyperpigmentation
• Recent significant sun exposure or tanning

Pre-Care & Post-Care Compliance

I agree to:

• Follow all pre-treatment and post-treatment instructions provided verbally or in writing
• Avoid contraindicated activities, products, or exposures as instructed (sun exposure, retinoids, acids, vitamin C, heat, exercise, saunas, swimming, etc.) for the recommended timeframes
• Apply broad-spectrum SPF 30+ daily and avoid sun exposure as directed
• Use only the products recommended by my provider during the recovery period
• Not pick, scrub, or manipulate treated skin
• Attend any required follow-up appointments
• Notify the clinic promptly if I experience unexpected reactions, prolonged or worsening symptoms, or signs of infection

I understand that failure to follow pre/post-care instructions may negatively impact results, increase risk of complications, and is not the responsibility of the practice.

Provider Scope & Supervision

I understand that aesthetic services at Navara Health may be performed by:

• Jessica Boggs, MSN, APRN, FNP-C, ENP-C — Advanced Practice Registered Nurse, treating provider and clinical oversight for all delegated services. Sole performer of CMA-certified procedures (Vampire Facelift®, Vampire Facial®).
• Rocio Gonzalez, RN — Registered Nurse, performing neurotoxin injections, dermal fillers, and general aesthetic services under written APRN delegation, Good Faith Exam oversight, and medical director protocols, consistent with Texas Board of Nursing and Texas Medical Board rules.
• Licensed estheticians performing services within the legal scope of esthetician practice in Texas (non-injectable services only)
• Trained clinical staff under appropriate supervision

I understand that injectable procedures, prescription products, and procedures requiring a Good Faith Exam are performed by or under the delegation of a licensed medical provider as required by Texas law. A Good Faith Exam will be completed (in person or via permitted telehealth where appropriate) prior to any injectable treatment performed by the RN injector.

No Medical Guarantee & Elective Nature

I understand and acknowledge that:

• Aesthetic services are elective and are not medical treatment for disease
• Aesthetic services do not replace primary care, dermatologic care, or treatment for any diagnosed condition
• Results are variable and influenced by age, genetics, skin type, health, lifestyle, and compliance with aftercare
• Maintenance treatments may be required to preserve results
• I may be dissatisfied with results, and dissatisfaction alone does not constitute substandard care

Financial Disclosure

I understand and agree that:

• Aesthetic services are elective and not covered by insurance
• Navara Health is a cash-pay practice and does not bill, verify, or submit claims to insurance, Medicare, or Medicaid for aesthetic services
• Payment is due at the time of service
• No refunds are issued once a service has been initiated (including product opening, injection, energy delivery, or peel application)
• Pre-paid packages, series, or memberships are non-refundable except as expressly stated in writing at the time of purchase
• Treatment of complications, prescription medications, or referrals may incur additional cost that is my financial responsibility
• Touch-up or maintenance procedures are separate billable services

Communication & HIPAA Authorization

I authorize Navara Health to communicate with me regarding scheduling, pre/post-procedure instructions, follow-up, product recommendations, and adverse event reporting through:

• The secure HIPAA-compliant patient portal
• Email to the address I have provided
• SMS / text message to the mobile number I have provided
• Telephone calls to the number I have provided

I understand that email and SMS are not fully secure channels. I may revoke authorization for any specific channel in writing to contact@navarahealthtx.com, except where required for legally mandated notices.

Assumption of Risk & Release of Liability

I acknowledge that aesthetic treatments are elective and voluntarily assume all known and unknown risks associated with the procedures I elect to receive. To the fullest extent permitted by law, I agree to release, indemnify, and hold harmless Navara Health, PLLC, Jessica Boggs APRN, the medical director, and all affiliated providers, nurses, estheticians, contractors, and staff from liability related to:

• Adverse reactions or complications
• Side effects or sensitivity reactions
• Cosmetic dissatisfaction with the result
• Lack of benefit or visible improvement
• Conditions not disclosed prior to treatment
• The need for additional, corrective, or maintenance procedures

This release does not apply to cases of gross negligence or willful misconduct, and does not waive any right that cannot lawfully be waived under the laws of the State of Texas.

Dispute Resolution & Binding Arbitration

Any dispute, controversy, or claim arising out of or relating to this Consent, the services provided, or the practitioner-patient relationship — including any claim of medical malpractice, billing dispute, or breach of contract — shall first be addressed by good-faith negotiation between the parties.

If the matter cannot be resolved through negotiation within thirty (30) days, the parties agree to submit the dispute to binding arbitration administered by a recognized arbitration body (such as the American Arbitration Association) under its applicable rules, with the arbitration to take place in Dallas County, Texas.

The parties acknowledge that by agreeing to arbitration, they are waiving the right to a jury trial. This provision does not waive any right that cannot lawfully be waived under Texas law. Either party retains the right to seek injunctive or equitable relief in court where appropriate.

Governing Law & Severability

This Consent shall be governed by and construed under the laws of the State of Texas. If any provision is found unenforceable, the remaining provisions shall remain in full force and effect.

Photography & Marketing Authorization

Photographs taken before, during, and after aesthetic services serve different purposes, and I am being asked to provide separate consent for each use. I understand I may consent to medical documentation while declining marketing use, or vice versa.