Client Liability Waiver & Release:

I am the person whose name appears on this appointment form and all information is correct to the best of knowledge. In addition, I understand that Kika’s Recovery is a luxury service, not a medical service or medical provider) intended to provide a comfortable and private setting to assist with mental and physical recovery following outpatient cosmetic surgery procedures. I understand that Kika’s Recovery is not a substitute for medical care or hospitalization and, as such, I am electing to use the services of Kika’s Recovery as a matter of convenience and not for reasons related to medical care. I hereby acknowledge that I am of legal age and of sound mental capacity and that I make this election free from duress or undue influences.
Check-In & Check-Out• Our check-in time is 3 pm and our check-out time is 12 pm. If you need to check-in early or check-out late, there is a surcharge and it is based upon availability. Please plan your flights accordingly. Even if your flight is in the morning on your final day, you will still have to pay for that day. 

◦ I understand that if an early check-in is available, I will be charged a fee of $50 to have access to a bed. Once check out time approaches, I understand that I will need to leave the premises or pay a late checkout fee, not exceeding $50. You may stay in the common area and there is a $50 fee to stay in a room (based on availability). Late check-out does not include transportation to the airport and I understand it will be my responsibility to transport myself to the airport any time after 8:00 pm.
◦ I understand that check-in time closes at 9:00 PM
Meals: I understand that my stay includes three meals per day at no additional cost.
◦ Kika’s Recovery does not cater to preferences and is unable to make changes to the menu upon your check-in.
◦ I understand that if I choose to upgrade my meal plan or have
dietary restrictions, the associated cost must be paid prior to my arrival.
◦ If I do not pay prior to my arrival, my meal plan will revert to classic.
◦ I agree to disclose all allergies prior to my arrival and understand if the information is not given to Kika’s Recovery prior to my arrival, I will need to provide my own meals and changes to accommodate my meals will commence the following day.
Airport Transportation:◦ I understand that Kika’s Recovery offers shared transportation service, and does not offer private car service.

◦ Kika’s Recovery does NOT transport pickups from Hotels, Airbnb, or any alternative locations.
◦ Transportation is reserved solely for patient use and is for transportation to Miami Airport and Surgery Centers
.◦ I understand that airport pick up times begins at 8:00 AM and ends at 6:00 PM MONDAY-SATURDAY
*If your Pre-Op appointment is on the same day as your incoming flight, we will meet you at and pick you up from the appointment instead of picking up from the airport.

Medical Risks and Responsibility
• Kika’s Recovery is not a medical facility and is a service to facilitate my recovery, monitor my recovery, and follow my Doctors discharge instructions.
◦ Further, I understand that my medical care, at all times, and in all circumstances remains the responsibility of the surgeon who performed my surgery.
◦ I understand that only my surgeon is authorized to write prescriptions for me and to determine outpatient recovery care is appropriate for my particular recovery needs.
◦ I understand that my surgeon is the only party with authority to order and perform post-operative medical treatment and he or she reserves the right, alone, to order my hospitalization, if that is the level of care I require.
◦ I further understand that my surgeon is the only party authorized to determine the level of post-operative care needed following my procedure, including whether discharging me to a non-medical facility, such as home or Kika’s Recovery is appropriate.
◦ I understand that I may be unsteady on my feet following surgery and I agree to request assistance getting out of bed for the first 24-hrs following surgery. In addition, while on pain medication, I agree to remain in my recovery suite at Kika’s Recovery unless accompanied by a friend, family member or Kika’s Recovery.
◦ In addition, I fully understand that it is MY responsibility to check with my surgeon, prior to my surgery date, for verification on which over-the-counter AND prescription medications I may take while recovering at Kika’s Recovery
◦ I agree to ONLY bring over-the-counter & prescription
medications, to Kika’s Recovery which my surgeon has verified I may
safely restart on arrival to the facility. I understand that it is my responsibility to place ALL approved medications, BOTH prescription and over-the-counter, in ONE MEDICATION BAG and store it in the safe provided by Kika’s Recovery.
Kika’s Recovery LLC does not administer medication. And is to remind you about your medication.
◦ Furthermore, I hereby agree to indemnify and hold harmless
Kika’s Recovery and all of its owners, agents, officers, directors, employees and affiliates from and against any and all loss, liability, damage, cost, expense (including reasonable attorneys’ fees and disbursements and costs of investigation), judgment, charge, fine, interest, penalty or assessment resulting from, arising out of, or relating to, any act, omission or state of facts and any demand, action, suit, proceeding, claim, assessment, judgment or settlement or compromise,
whether known or unknown, of any kind whosoever that I may sustain in connection with choosing not to comply with Kika’s Recovery medication policy stated here.
Medications & Prescriptions• Rx pickups, injections, and additional medical supplies cost are absorbed by you. Any additional medical supplies will accrue a fee.
◦ We require you to bring cash to purchase your prescriptions. If for some reason you do not have cash or your method of payment fails and we must pay for your prescriptions, we have a 3% transaction fee that is added to the cost of your prescriptions.
◦ Prescription drop off concludes at 5:00 PM and prescriptions will be taken to the pharmacy the following morning. The only exception is if the prescription was given on the day of surgery.
◦ Kika’s Recovery Drivers are only permitted to go to Walgreens or
Cvs to fill prescriptions. This is to avoid any delays with filling your prescriptions. You will have to provide your own transportation to an alternate pharmacy should you choose to decline the services at Walgreens Pharmacy or Cvs.
◦ I understand it may take up to 8 hours to fill my prescriptions and Kika’s Recovery has no control over the given times at the pharmacy.
◦ Again, I agree to ONLY bring over-the-counter & prescription
medications, to Kika’s Recovery, which my surgeon has verified I may
safely restart on arrival to the facility.
◦ Again, I hereby agree to indemnify and hold harmless Kika’s Recovery and all of its owners, agents, officers, directors, employees and affiliates from and against any and all loss, liability, damage, cost, expense (including reasonable attorneys’ fees and disbursements and costs of investigation), judgment, charge, fine, interest, penalty or assessment resulting from, arising out of, or relating to, any act, omission or state of facts and any demand, action, suit, proceeding, claim, assessment, judgment or settlement or compromise, whether known or unknown, of any kind whosoever that I may sustain in connection with choosing not to comply with Kika’s Recovery medication policy stated here.

No Smoking Policy• I understand Kika’s Recovery has a strict NO SMOKING policy and I will be fined $500 I found smoking in my room. I understand that smoking causes significant detriment to my body’s ability to heal and greatly increases my risk of post-op complications. I hereby agree NOT to smoke while at Kika’s Recovery.
◦ I also agree NOT to request the assistance of Kika’s Recovery staff member, hotel employee or any other person to assist me outside to smoke.
◦ Should I decide to smoke and breach this contract, I am doing so at my own risk. I hereby agree to indemnify and hold harmless.

Kika’s Recovery and all of its owners, agents, officers, directors, employees and affiliates from and against any and all loss, liability, damage, cost, expense (including reasonable attorneys’ fees and disbursements and costs of investigation), judgment, charge, fine, interest, penalty or assessment resulting from, arising out of, or relating to, any act, omission or state of facts and any demand, action, suit, proceeding, claim, assessment, judgment or settlement or compromise, whether known or unknown, of any kind whosoever that I may sustain in connection with choosing to smoke while at Kika’s Recovery.
Transportation• I hereby assume all risk and personal injury, sickness, death, damage, and expenses as a result of participation in transportation activities involved with Kika’s Recovery. Further, authorization and permission are hereby given to furnish any necessary transportation, and I hereby agree to hold harmless and indemnify Kika’s Recovery and all of its owners, agents, officers, directors, employees, and affiliates for any liability sustained by services provided by Kika’s Recovery as a result of the negligent. Willful or intentional acts of Kika’s Recovery including expenses incurred attendant thereto and hereby give permission to hospitalize and hereby authorize medical treatment, including but not limited to emergency surgery or medical treatment, and assume the responsibility of all medical bills if any. I understand that this is a legally binding release and consent.
◦ I have carefully read this Release of Liability and Consent for Transportation and Medical Treatment policy, outlined here and fully understand its contents. Being aware of said contents, I sign of my own free will.

◦ I understand that whenever myself, a family member or friend will be transported, that I hereby release and Kika’s Recovery and all of its owners, agents, officers, directors, employees and affiliates harmless from any and all loss, liability, damage, cost, expense (including reasonable attorneys’ fees and disbursements and costs of investigation), judgment, charge, fine, interest, penalty or assessment resulting from, arising out of, or relating to, any act, omission or state of facts and any demand, action, suit, proceeding, claim, assessment, judgment or settlement or compromise, whether known or unknown, of any kind whatsoever that I, a family member or a friend, may sustain in connection with the services provided to me by Kika’s Recovery or any of the foregoing.

Cancellations
• In order to provide the best experience possible for our guests, if you need to cancel your stay with us for any reason, please email us as we need the cancellation in writing.
◦ You must cancel at least one month before your check-in date, the deposit is non-refundable.
◦ If you choose to reschedule, you must contact us two weeks prior to your check-in date.
◦ Again, you are encouraged to use your deposit to reschedule your stay for a later date . If you have not contacted us within the two-week timeframe to reschedule, you forfeit not only your deposit but all monies paid.
◦ No changes can be made to your reservation once you check in. If you must depart early, you forfeit your deposit and all monies paid.
◦ If your full balance is not paid within 2 weeks of check-in you must contact us to make a payment or your reservation will be canceled, and you forfeit any monies paid. If we do not receive prior notice based on our cancellation policy you will forfeit your deposit or any monies paid.

◦ You must submit all required forms, financial obligations, and provide flight information at least 7 days prior to your arrival or we reserve the right to cancel your reservation and you forfeit all monies paid.
◦ We are unable to plan for your stay or transportation without your flight details.
Loss & Damage: • Kika’s Recovery shall not be liable for any lost or damaged items during your stay. Kika’s Recovery recommends that you bring any personal property at your own risk. If you should leave any item(s) behind, you are responsible to pay the postage to return those items.

Code of Conduct
• Kika’s Recovery is a Recovery Home and we promote an environment that is conducive to healing. We require that you speak in a low tone while within the facility and be considerate of other guests and our staff. We do not allow any profanity inside or on the premises of our facility. We require that you are respectful towards all guests and our staff at all times. Additionally, you must use headphones while on FaceTime or any video call. We do not allow the use of speakerphone in order to preserve the peace of our other guests. We do not allow any video recording, going on “live” on social media without acknowledgment of the owner of Kika’s Recovery. Failure to follow this code of conduct will result in removal from our facility and you will forfeit all the monies paid.

• In consideration of the foregoing, I still elect to utilize the services of Kika’s Recovery. I agree to indemnify and hold harmless Kika’s Recovery and all of its owners, agents, officers, directors, employees and affiliates from and against any and all loss, liability, damage , cost, expense (including reasonable attorney’s fees and disbursements and costs of investigation), judgment, charge, fine, interest, penalty or assessment resulting from, arising out of, or relating to, any act, omission or state of facts and any demand, action, suit, proceeding, claim, assessment, judgment or settlement or compromise, whether known or unknown, of any kind whatsoever that I may sustain in connection with the services provided to me by Kika’s Recovery or any of the foregoing.

Client Liability Waiver & Release Consent*
Yes, I acknowledge that I have read and understood the terms outlined in Kika’s Recovery Liability Waiver & Release document.
Yes, I understand, that I must cancel within one month, and deposits are non-refundable and that if I choose to reschedule, I must contact Kika’s Recovery within two weeks prior to my scheduled check-in date.
Yes, I understand, if I have not contacted Kika’s Recovery within the two weeks prior to scheduled check-in date, I forfeit not only my deposit but all monies paid.
Yes, I understand, that if my full balance is not paid within 7 days of scheduled check-in I must contact Kika’s Recovery to make payment or my reservation will be canceled and I forfeit any monies paid.
Yes, I understand, that Kika’s Recovery is not a Medical facility and does not provide Medical treatment.

You agree that you shall not make any claims against Kika’s Recovery (hereafter known as “Kika’s Recovery”) and specifically waive any and all rights you may have to assert any claim against Kika’s Recovery, pursuant to this agreement for any damages and/or legal fees which may be sustained as a result of any liability asserted against or imposed upon you for the violation of any law, statute or regulation, or any civil liability or damages asserted against or sustained or incurred by you or any others, arising out of advice Kika’s Recovery You also agree to indemnify, hold harmless and defend Kika’s Recovery against any claim or liability which may be brought back against or imposed upon Kika’s Recovery, including but not limited to reasonable attorneys’ fees to defend against such, as a result of any action or lack of action by you or others as a result of the services rendered pursuant to this agreement, whether such claims are asserted by or against you by others, or against me by you or others.

Yes, I acknowledge that I have read and agree to the terms of Kika’s Recovery
Recovery Companion Terms & Agreement
You agree that you shall not make any claims against Kika’s Recovery (hereafter known as “Kika’s House”) and specifically waive any and all rights you may have to assert any claim against Kika’s Recovery, pursuant to this agreement for any damages and/or legal fees which may be sustained as a result of any liability asserted against or imposed upon you for the
violation of any law, statute or regulation, or any civil liability or damages asserted against or sustained or incurred by you or any others, arising out of advice Kika’s Recovery renders to you.
You also agree to indemnify, hold harmless and defend Kika’s Recovery against any claim or liability which may be brought back against or imposed upon Kika’s Recovery including but not limited to reasonable attorneys’ fees to defend against such, as a result of any action or lack of action by you or others as a result of the services rendered pursuant to this agreement, whether such claims are asserted by or against you by others, or against me by you or others.

Acknowledgment of Guest Terms & Agreement
****Please Note: We are not responsible for cleaning up after Companions that make flight reservations other than with the clients are responsible for their own flight If a companion should leave the recovery home, they should keep in mind that they will not be able to re-enter after 9PM.

Kika’s Recovery House, LLC