Patient Name:
Patient Name is required.

Article 1. It is understood that any and all disputes between the Patient and LaserAway that relate to the provision of care, treatment, and services LaserAway provides to the Patient, including any action for injury or death arising from intentional torts, statutory causes of action, negligence, and medical malpractice, that is as to whether any medical services rendered under this contract were unnecessary or unauthorized or were improperly, negligently, or incompetently rendered shall be determined by submission to binding arbitration and not by lawsuit or resort to court process. To the extent that Patient brings claims arising under or related to the LaserAway Website Terms and Conditions located at, including without limitation claims regarding LaserAway’s advertising and business practices, such claims will be determined by submission to binding arbitration as set forth in Exhibit A hereto. For purposes of this Agreement, “LaserAway” shall mean and include all of the following: LaserAway, LLC, its parent and subsidiary companies, affiliated entities, LaserAway branded clinics that are independently owned, each of the foregoing’s vendors, and the directors, officers, employees, or other representatives of each of them.

Article 2. This Agreement shall be binding for any and all disputes arising out of the Patient’s treatment at LaserAway, except for disputes pertaining to collections or evictions. This Agreement is binding on all parties herein, including LaserAway, Patient, the Patient’s representatives, executors, family members, and heirs and those who may bring any claims individually or in a representative capacity. The Patient’s representatives, agents, executors, family members, successors in interest and heirs who execute this Agreement below on the signature line are doing so not only in their representative capacity for the Patient, but also in their individual capacity and thus agree that any and all claims brought individually by any such representatives, agents, executors, family members, representatives, successors in interest and heirs are subject to binding arbitration.

Article 3. The parties to this agreement are giving up their Constitutional right to have any and all disputes decided in a court of law before a jury, and instead are accepting the use of binding arbitration. By signing this agreement, the parties waive their right to commence and/or be a party to any class or collective action in any court against the other party relating in any manner to the Patient’s treatment at LaserAway. Further, the parties waive their right to commence or be a party to any group, class, or collective action claim in arbitration or any other forum

Article 4. The execution of this Arbitration Agreement is not a precondition to receiving medical treatment, care, services and/or for treatment at LaserAway and is not a requirement to continue to receive medical treatment, care and services at LaserAway. This Agreement may be rescinded by written notice to LaserAway within thirty (30) days of signature.

Article 5. Retroactive Effect. It is agreed by and between the parties hereto that this Agreement covers services rendered before the date this contract is signed, thus making this contract effective as of the date of the Patient’s first visit to LaserAway.

Article 6. This Agreement relates to the Patient’s treatment at LaserAway and LaserAway procures supplies from out of state vendors. The parties, therefore, agree that the underlying treatment at LaserAway involves interstate commerce. The parties further agree that this Agreement is to be governed by the Federal Arbitration Act and the procedural rules set forth in the Federal Arbitration Act (9 U.S.C. Sections 1-16) shall govern any petition to compel arbitration and shall preempt State procedural law. While the parties agree that this agreement shall be governed by the procedural rules set forth in the Federal Arbitration Act, the parties further agree that the substantive law of the State where LaserAway is located shall apply to any and all claims arising out of the Patient’s treatment at LaserAway.

Article 7. The parties are to mutually agree on the appointment of a single neutral arbitrator who is associated with a mediation and/or arbitration agency that routinely conducts mediations and/or arbitrations in the State where LaserAway is located and agree that discovery will be conducted pursuant to the discovery rules set forth by the arbitrator and the associated mediation and/or arbitration agency selected. Should the parties be unable to mutually agree upon the appointment of a single neutral arbitrator the Federal Arbitration Act shall govern the appointment of the arbitrator. The arbitration shall be venued in a location convenient for all parties, normally the county or region where LaserAway is located.

Article 8. The expenses and fees of the arbitrator(s) shall be apportioned equally among all parties except as otherwise permitted or required by law.

Article 9. If any provision in this Agreement is held invalid, such holding shall not impact the validity of the remaining provisions of this Agreement.

The Patient and/or the person executing this Agreement certifies that he/she has read this Agreement, understands this Agreement, it has been explained to them in a manner he/she understands, has been given a copy of this Agreement, and affirmatively represents that he/she is duly authorized by virtue of the Patient’s consent, instruction and/or durable power of attorney, to execute this Agreement and accept its terms on behalf of the Patient and acknowledges that LaserAway is relying on the aforementioned certification.

LaserAway Representative’s Signature:
I agree to use an electronic signature to demonstrate my acceptance of this agreement. I understand that this electronic signature is as legally binding as an ink signature. Patient’s Signature (type your name):
Patient’s Signature is required.



Both you and LaserAway waive the right to a trial by jury and the right to bring or resolve any dispute as a class, consolidated, representative, collective, or private attorney general action arising under or relating to the LaserAway Website Terms & Conditions (“the Terms” or “these Terms”), including without limitation claims relating to LaserAway’s advertising and business practices (the “Covered Disputes”). All capitalized terms in this Exhibit A shall have the meaning given to them in the Terms. Both you and LaserAway waive the right to participate in a class, consolidated, representative, collective, or private attorney general action related any dispute that is brought by anyone else. Notwithstanding any provision in the JAMS rules to the contrary, the arbitrator will not have the authority or any jurisdiction to hear the arbitration as a class, consolidated, representative, collective, or private attorney general action or to consolidate, join, or otherwise combine the claims of different persons into one proceeding.

Except for disputes relating to the infringement of your or LaserAway’s intellectual property (such as trademarks, trade dress, copyright and patents) or where LaserAway is seeking injunctive relief (the “Excluded Disputes”), you and LaserAway each agree to finally settle all Covered Disputes only through arbitration. In arbitration, there is no judge or jury and review is limited. The arbitrator’s decision and award is final and binding, with limited exceptions, and judgment on the award may be entered in any court with jurisdiction. The parties agree that, except as set forth above, any claim, suit, action or proceeding arising out of or relating to these Terms or your use of the Sites (including purchasing products or services through the Sites) will be resolved solely by binding arbitration before a sole arbitrator under the Streamlined Arbitration Rules & Procedures of JAMS Inc. (“JAMS”) or any successor to JAMS. In the event JAMS is unwilling or unable to set a hearing date within thirty (30) days of the filing of a “Demand for Arbitration,” then either party can elect to have the arbitration administered by another mutually agreeable arbitration administration service that will hear the case. You may choose to have the arbitration conducted by telephone, based on written submissions, or in person in the county where you live or at another mutually agreed location. The federal or state law that applies to these Terms will also apply during the arbitration. Disputes will be arbitrated only on an individual basis and will not be consolidated with any other proceedings that involve any claims or controversy of another party, including any class actions or class arbitrations; provided, however, if for any reason any court or arbitrator holds that this restriction is unconscionable or unenforceable, or for any Excluded Disputes, then the agreement to arbitrate does not apply and the dispute must be brought in a court of competent jurisdiction as set forth in the next paragraph.

By visiting the Sites, you agree that the Federal Arbitration Act, applicable federal law, and the laws of the State of New York, without giving effect to any conflict of law provisions, together with the JAMS (defined below) rules, shall govern any proceeding that occurs in arbitration. In the event any claim is found not to be arbitrable, such claim shall be brought in a court of competent jurisdiction in New York, New York and the normal choice-of-law rules shall apply to such proceeding.

Subject to you demonstrating that the costs of arbitration will be prohibitive as compared to the costs of litigation, LaserAway will pay as much of the administrative and arbitrator’s fees charged to you by JAMS (or an alternate arbitration service) as the arbitrator deems necessary to prevent the arbitration from being cost prohibitive to you as compared to litigation. Either party may, notwithstanding this provision, bring qualifying claims in small claims court. In no event will you seek or be entitled to rescission, injunctive or other equitable relief or to enjoin or restrain the operation or exploitation of the Services or any other property of LaserAway (provided that nothing in these Terms will restrain a California resident’s right (if any) under applicable law to seek public injunctive relief in accordance with this dispute-resolution provision).

You and LaserAway agree that, in the event that there are fifty (50) or more individual requests for arbitration of a similar nature filed against LaserAway within an approximately thirty-day period (or otherwise in close proximity), JAMS will administer all such similarly situated arbitration demands on a collective basis as a single, consolidated arbitration (subject to a single set of fees, proceeding schedule, and, if required, hearing) before a single arbitrator in accordance with the requirements outlined elsewhere in this section, provided that – in the event that the arbitrator deems it impracticable or inequitable to administer all such claims collectively in a single arbitration – (s)he may group demands for arbitration into groups of not fewer than twenty (20) matters, plus a remainder group as needed (or as otherwise deemed by the arbitrator to be practicable, equitable, and in best keeping with the spirit of this provision) and arbitrate each group of matters as a single, consolidated arbitration (either structure a “Batch Arbitration”). You and LaserAway agree (a) to work with JAMS in good faith to facilitate the resolution of disputes on a Batch Arbitration basis and (b) that requests for arbitration are of a “similar nature” if they arise out of the same event, agreement, or factual scenario and raise the same or similar legal issues and seek the same or similar relief. Disagreements over the applicability of this Batch Arbitration process will be settled in a single, consolidated arbitration proceeding that includes all affected parties and is resolved by a single arbitrator subject to the requirements of this section. This Batch Arbitration provision will in no way be interpreted as authorizing a class or collective arbitration or action of any kind, or any suit or arbitration involving joint or consolidated claims, under any circumstances other than those expressly set forth in this section.

The rules of JAMS and additional information about JAMS are available on the JAMS website. By agreeing to be bound by these Terms, you either (a) acknowledge and agree that you have read and understand the rules of JAMS or (b) waive your opportunity to read the rules of JAMS and any claim that the rules of JAMS are unfair or should not apply for any reason.