I have read the medspa board certification requirements and agree that all of the following is accurate:

• I am the medical director and have the ultimate responsibility to ensure that the medical spa is operating in a safe and compliant manner.
• I possess the appropriate education, training, experience and competence to safely administer, delegate and supervise each aesthetic medical treatment at the medical spa
• I hold an active, unrestricted license to practice medicine (or other licensure permitted under applicable state law) in the state(s) where the medical spa operates.
• I ensure appropriate supervision of each medical aesthetic treatment performed at the medical spa
• I ensure that every new patient receives a Good Faith Exam performed by a qualified provider (physician, PA, or NP) prior to any medical aesthetic treatment, as required under Medspa Board certification requirements.
• I accept ultimate responsibility for the safety of the patients treated at the medical spa
• I ensure that the medical spa’s providers are trained and qualified to provide the procedures they have been tasked to provide
• I ensure the medical spa is equipped with all necessary equipment, supplies and processes to address medical complications and emergencies. I ensure that the staff is trained to treat vascular occlusion and that we always maintain at least 16 vials of hyaluronidase in case of emergency. I maintain a written vascular occlusion response plan, which is reviewed at least annually.
• I ensure that no provider under my supervision will use any non-dissolvable dermal fillers, including Radiesse and BellaFill. If radiesse is ever used in my practice, it is only used in hyper-dilute fashion as a biostimulator.
• I have read the IV infusion Standard and ensure that all requirements are met In my practice.
• I do not offer, and no provider under my supervision offers, NAD/NAD+, intravenous iron, biologic or monoclonal-antibody infusions, sedating or anesthetic IV medications, or any other infusion identified as prohibited or high-risk in the Medspa Board IV Infusion Therapy Standard.
• I have confirmed with the medical spa's malpractice/liability carrier that each specific IV therapy offered is a covered service, and I will reconfirm coverage with the carrier before any new IV therapy type is added.
• I ensure that an AED/defibrillator, bag-valve-mask, blood pressure and pulse oximetry equipment, and epinephrine are immediately accessible wherever IV therapy is administered.
• I ensure that all staff administering IV therapy hold current BLS certification.
• I have developed and signed written protocols for aesthetic medical treatment to be performed at the medical spa.
• I have malpractice insurance that covers my medical practice at the spa.
• I certify that the medical spa's clinical operations comply with applicable HIPAA privacy and security requirements, OSHA bloodborne pathogen and workplace safety standards, and FDA requirements governing the medical devices, drugs, and products used in the practice, including adverse event reporting obligations.
• I will inform the Medspa Board if I cease employment as medical director for the spa
• I will promptly inform the Medspa Board of any investigation, restriction, suspension, or revocation of my medical license.
• I have provided my current medical license number and NPI as part of this application, and I consent to being identified as the medical spa's medical director on its website and physical signage.

By signing below, I affirm that all information provided in this attestation is true, complete, and accurate, and that I will continue to fulfill my duties in accordance with the MedSpa Board Certification Requirements.