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Last Name

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Are you over 18?

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Quick Health Check- Check any that apply to you

Pregnant or possibly pregnant

Allergy or sensitivity to adhesive tape or latex

Cut, rash, infection, piercing wound or skin condition on or near your ears

Pacemaker or other implanted electronic device

Bleeding disorder or taking blood thinners

Recent ear surgery or injury

What ear seeding is

Ear seeding places small seed or bead on adhesive tape over points on the outer ear. It is based on traditional Chinese wellness practices. Nothing punctures the skin. You can remove the seeds at any time. Most people wear them 3 to 5 days.

Possible effects include mild tenderness, skin redness or irritation from the adhesive, and, rarely, a seed coming loose. Remove the seeds and contact me if you have pain, swelling, itching or signs of infection.

Nevada wellness services disclosure (NRS 629.580)

Shalane Carter, DNM (PRNA Wellness, 305 Queen Creek Cir Henderson, NV 89052, (702)525-4809) is not licensed, certified or registered as a provider of health care in the State of Nevada. Her training includes a Doctor of Natural Medicine (DNM) credential and study of aspects of traditional Chinese medicine. Ear seeding is a wellness service. It does not diagnose, treat or cure any disease and is not a substitute for medical care.

It is recommended that before beginning any wellness plan, you notify your primary care physician or other licensed providers of health care of your intention to use wellness services, the nature of the wellness services to be provided and any wellness plan that may be utilized. It is also recommended that you ask your primary care physician or other licensed providers of health care about any potential drug interactions, side effects, risks or conflicts between any medications or treatments prescribed by your primary care physician or other licensed providers of health care and the wellness services you intend to receive.

By checking this box, I understand. I have read the disclosure above. I understand that Shalane Carter is not a licensed health care provider in Nevada, that ear seeding is not medical care, and that I should keep following any treatment my doctor has prescribed. My health check answers are accurate.

Yes, I understand

Release of liability: By checking this box, I CHOOSE TO RECEIVE EAR SEEDING VOLUNTARILY AND ACCEPT THE RISKS DESCRIBED ABOVE. I RELEASE PRNA LLC, DOING BUSINESS AS PRNA WELLNESS, AND SHALANE CARTER FROM ANY CLAIMS ARISING FROM THIS SERVICE, INCLUDING CLAIMS BASED ON THEIR ORDINARY NEGLIGENCE. This release does not cover gross negligence, recklessness or intentional misconduct, or any claim Nevada law does not allow me to waive.

Yes, I understand

By checking this box, I consent to receive non-marketing text messages from PRNA LLC about NATURAL HEALTH, WELLNESS PRACTICES AND OTHER OFFERING OF PRNA LLC. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others, from PRNA LLC at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

Date

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Las Vegas Menopause Event

Ear Seeding Waiver and Registration

What ear seeding is

Nevada wellness services disclosure (NRS 629.580)