Lumora Luxe — Service Informed-Consent & Acknowledgment (Non-Medical)

DRAFT — PENDING COUNSEL REVIEW

THIS IS A DRAFT PREPARED FOR ATTORNEY REVIEW. IT IS NOT LEGAL ADVICE AND IS NOT EFFECTIVE UNTIL REVIEWED, REVISED, AND APPROVED BY QUALIFIED LEGAL COUNSEL LICENSED IN THE APPLICABLE JURISDICTION(S). ALL BRACKETED ITEMS (e.g., [EFFECTIVE DATE], [STATE]) ARE PLACEHOLDERS TO BE COMPLETED. DO NOT USE THIS DOCUMENT TO OBTAIN CONSENT IN ITS CURRENT FORM.

Effective Date: [EFFECTIVE DATE] Governing State: [STATE]

Please review this acknowledgment before each service. You will be asked to confirm it as part of your booking. It is designed to help you and your Professional deliver a safe, comfortable, and beautiful experience.

1. Nature of the Service

You are booking a cosmetic, beauty, and/or wellness service (the "Service") through the Lumora Luxe platform ("Lumora Luxe," "the Company," "we"). The Service will be performed by an independent, licensed non-medical professional (the "Professional"), either at a location you designate (mobile) or at the Professional's office.

You understand and agree that:

• The Service is non-medical in nature and is intended for cosmetic, aesthetic, relaxation, and/or general wellness purposes.
• The Professional is an independent contractor — a separate, independently licensed business — and is not an employee or agent of Lumora Luxe. Lumora Luxe provides the technology platform and facilitates booking and payment; the Professional is solely responsible for the performance of the Service.

2. Not Medical Treatment

The Service is not medical care and is not a substitute for professional medical advice, diagnosis, or treatment. The Professional does not diagnose, treat, or cure any medical condition through the Service.

• Nothing provided in connection with the Service should be interpreted as medical advice.
• If you have any medical condition, concern, or symptom, or before making any decision that could affect your health, consult a qualified licensed physician or other appropriate healthcare provider.
• Never disregard, avoid, or delay obtaining medical advice because of anything related to the Service.

3. Disclosure of Relevant Conditions

For your safety and comfort, you agree to disclose to your Professional, before the Service begins, any information that may be relevant to the Service, including but not limited to:

• Known allergies or sensitivities (for example, to adhesives, dyes, fragrances, latex, metals, botanicals, or specific products or ingredients);
• Skin conditions, irritations, recent sunburn, open wounds, rashes, or areas of concern in the treatment area;
• Recent cosmetic or aesthetic procedures in or near the treatment area;
• Pregnancy, nursing, or other conditions that may affect suitability of certain products or services; and
• Any prior adverse reaction to a similar service or product.

You understand that the Professional relies on the accuracy and completeness of the information you provide, and that failure to disclose relevant information may increase the risk of an adverse reaction or an unsatisfactory result. If you are unsure whether the Service is appropriate for you, consult a qualified healthcare provider before proceeding.

4. Patch Testing (Where Applicable)

Certain services — for example, lash extensions, lash/brow tinting, henna, or services using adhesives or dyes — may carry a risk of allergic reaction or sensitivity. Where relevant, a patch test performed in advance can help identify a potential reaction.

• You acknowledge that a patch test may be recommended for certain services, and that you may decline a recommended patch test.
• If you decline a recommended patch test, you do so voluntarily and assume the associated risk, including the risk of an allergic or sensitivity reaction.
• A patch test reduces but does not eliminate the risk of a reaction; reactions can still occur even after a negative patch test.

Patch test acknowledgment (where applicable): ☐ A patch test was recommended and performed. ☐ A patch test was recommended and I declined it, and I accept the associated risk. ☐ A patch test was not applicable to this Service.

5. Results May Vary; No Guarantee

You understand and agree that:

• Results vary from person to person and depend on many factors, including your individual characteristics, skin/hair type, aftercare, and adherence to any guidance the Professional provides.
• Results are not guaranteed. Descriptions, photos, or examples are illustrative only and are not a promise of any particular outcome.
• Some services may produce temporary redness, sensitivity, or other minor, expected effects, and results may change over time.

6. Assumption of Risk & Aftercare

You voluntarily choose to receive the Service and accept the ordinary risks associated with cosmetic, beauty, and wellness services, including the possibility of sensitivity or reaction even where reasonable care is taken. You agree to follow any reasonable aftercare instructions provided by your Professional. This acknowledgment is not intended to release any party from liability for its own negligence or misconduct, and nothing here waives any right that cannot be waived under applicable law. (Counsel to confirm scope and enforceability of any risk/release language under [STATE] law.)

7. Emergency Guidance

If you experience a medical emergency, a severe allergic reaction, difficulty breathing, or any urgent medical symptom, stop the Service immediately and call 911 (or your local emergency number) or seek immediate medical attention. For non-urgent reactions or concerns following a Service, contact a qualified healthcare provider, and please also notify your Professional and Lumora Luxe so we can assist and document the matter.

8. Photo / Media Consent (Optional)

Professionals may wish to take before-and-after or in-progress photos or media of the Service for records, quality, or portfolio/marketing purposes. This is optional and requires your consent.

• Granting or declining photo/media consent will not affect your ability to receive the Service.
• You may specify limits (for example, no facial identification), and you may withdraw consent prospectively at any time by notifying your Professional and Lumora Luxe. (Withdrawal does not require the removal of media already published, though we will make reasonable efforts where feasible.)

Please select one: ☐ I CONSENT to the capture and use of photos/media of my Service as described above. ☐ I DO NOT CONSENT to any photos/media of my Service. Optional limitations: ______________________________________________

9. Payment

You understand that payment for the Service is processed through Stripe via the Lumora Luxe platform, and that any deposit, cancellation, or rescheduling terms presented at booking apply to your Service.

10. Acknowledgment & Consent

By signing (or electronically accepting) below, I acknowledge and agree that:

1. I have read and understood this Service Informed-Consent & Acknowledgment.
2. I am at least eighteen (18) years old and have the legal capacity to consent to the Service.
3. The Service is non-medical and not a substitute for medical advice or treatment.
4. I have had the opportunity to disclose relevant allergies, sensitivities, skin conditions, and other relevant information to my Professional, and the information I have provided is accurate and complete to the best of my knowledge.
5. I understand the patch-test information in Section 4 and have indicated my election above (where applicable).
6. I understand that results vary and are not guaranteed.
7. I understand the emergency guidance in Section 7.
8. I have made my photo/media election in Section 8.
9. The Professional is an independent contractor and not an employee or agent of Lumora Luxe.
10. I voluntarily consent to receive the Service.

11. Consent / E-Signature Block

Electronic acceptance. If you accept this acknowledgment electronically, you agree that your electronic acknowledgment (including checking a box and/or clicking "I Agree," together with a date/time stamp and record retained by Lumora Luxe) constitutes your signature and has the same legal effect as a handwritten signature, consistent with applicable electronic-signature laws (e.g., the federal E-SIGN Act and applicable [STATE] law).

☐ I AGREE — I have read, understood, and consent to this Service Informed-Consent & Acknowledgment.

This document is a DRAFT prepared for attorney review. Bracketed items are placeholders. Counsel should confirm consent scope, any assumption-of-risk/release language, patch-test and aftercare standards, electronic-signature compliance, and consistency with applicable [STATE] cosmetology/esthetics regulations before use.