Waiver Consent form

Full Name *

Email *

Phone *

*REQUIRED: By checking this box, I agree to Keloretta’s waiver terms and conditions.

Optional:

Transactional SMS Opt-in

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested from Keloretta. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Marketing SMS Opt-in

By checking this box, I consent to receive marketing and promotional messages from Keloretta, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Waiver Signature *

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