I understand that a topical anesthetic cream (“numbing cream”) may
be offered to me prior to the Treatment. In rare cases this numbing cream may cause
life-threatening side effects including irregular heartbeat, seizures, breathing difficulties, coma or
even death. Thus, if I choose to use this cream, I agree that I will not use this numbing cream
for a longer period of time than recommended (30 minutes} and that I will not apply it to
broken/irritated skin, mucous membranes (mouth, vagina, anus) or an open cut or wound. I
agree to not use more than the amount recommended. Also for my safety, and the safety of
others, I agree to keep it out of the reach of children and agree to not operate a vehicle while
using the topical anesthetic. I agree to only use this numbing cream as instructed.