hair removal consent form english

File Number:

HAIR REMOVAL CONSENT FORM

• Laser Hair Removal is more effective for black and thick hair. It does not work at all on white, fine and lighter hair.

• Laser Hair Removal only affects a certain phase (active phase).

• The effectiveness of each session will show after 3 weeks.

• In some cases especially with men (beard) there is no guarantee to have a straight neck line.

• Time between each session is necessary (usually 4-8 weeks).

• The hairs will not necessary decrease after each treatment.

• LHR may result in the following side effects like: burn, scars, hypopigmentation, hyperpigmentation, itching, swelling of the skin and increase of white hair.

• Side effects can be diminished with time but in some cases can stay longer or even permanent.

• In some cases laser may cause increase in hair growth and thickness.

• History of any Dermal Fillers / Botox or Tattoos must be informed

• Protective eyewear (shields) will be provided to you during the treatment. Failure to wear eye shields during the entire treatment may cause severe and permanent eye damage.

• Laser treatments are not advised for pregnant women.

• Laser treatments are not recommended right before an important event because reactions vary after each session

• The number of sessions on different areas varies from person to person therefore, results cannot be estimated

• The results are staged, no guarantees can be or have been made

• There are no refunds for services rendered.

• Choice of suitable laser machine for the treatment is done by the doctor

I am a competent consenting adult of at least 18 years of age (or my parent or legal guardian is giving consent on my behalf), and further:

• Pre and post treatment instructions have been explained to me

• Have had the opportunity to ask questions, and all of my questions have been answered to my satisfaction

• Must notify the clinician if my medical history changes prior to subsequent treatments

• I consent to clinical photographs being taken of my treated areas for my personal health record only

• My signature below constitutes my acknowledgment and understanding of all this information

Patient Name

Patient Signature

Date /Time

Parent or Guardian (if patient is minor)

Witness