MODEL DISCLAIMER
As part of the certification process, the Arizona Department of Health Services requires the Laser Intern Clinician to complete the required ten (10) practical applications per course. These applications must be performed on live models under the direct supervision of the laser instructor. Models are accepted according to the following key points:
• Must be at least 18 years of age.
•Must sign a Model Waiver Form, stating they understand that a Laser Intern Clinician will be performing the treatment under the direction of the MALE or KEFI laser personnel.
• Must complete all medical documentation and informed consent forms.
• Must complete and agree to all written treatment instructions both pre and post treatment issued by
MALE or KEFI personnel.
• Must agree and sign photograph/video consent form to photo/video publication for advertising, educational or marketing purpose (name will not be used).
• Must agree to the use of any pre and post prescription requirements (such as pigment cremes, retinols or skin care products) as recommended by MALE or KEFI.
• Model understands that they may or may not have the same Laser Intern Clinician for all plan of treatment appointments, therefore accepts treatment from any other Laser Intern Clinician.
• Must agree to the model payment agreement:
o Model will receive a written quote of treatment and all model fees are paid to KEFI Advanced Laser
and Skin prior to treatment
o The Model consultation and first two scheduled treatments are complementary for each modality course taught.
o A Model fee is applied for any subsequent treatments with a 30% discount to any plan of treatment.
o “No Show” appointments, without 24-hour notice, forfeit any future complementary treatments or discounts.
o All Model fees are due at the time of service.
