Self Assessment
Choose Consent Form
Laser Hair Removal
Consent for Laser Hair Removal
I hereby authorize AL DIMASHQI MEDICAL CENTER (DMC) to perform laser hair removal (LHR) on me. I understand that this procedure works on the growing hairs and not on dormant hairs. Therefore hair loss will be gradual and the treatment requires several sessions to obtain a significant, long-term reduction of hair growth. I understand that it is effective on hair with color and less effective on grey, blond, or red hair and may not treat white hair. A general range of 4 - 8 sessions spaced 4 - 6 weeks apart is possible for maximum results and hair reduction by 85 - 90% on average. The number of sessions needed depends on the body location, the amount of hair present, character of the hair, skin type, genetics, hormones and medication as well as compliance with pre/post treatment instructions. All of these factors interfere with LHR process and some rare cases may have very little or no response at all to laser therapy. This may not be determined until after a few sessions. Clients new to LHR are advised to start treating small areas like under arms rather than full body or large areas to gain the experience and check their response to the treatment.
Pre, during and Post Treatment sessions Instructions:
I understand that compliance with Pre, during and Post treatment guidelines, presented, discussed and handed to me are crucial for success of LHR and for minimizing any undesirable side effects and complications.
Adverse experiences or side effects
- Some discomfort may be experienced during and after treatment. This discomfort is typically minimal but if the treated area is very uncomfortable, oral pain reliever; such as Extra Strength Tylenol or Panadol Extra may be used.
- Short term redness is common and swelling of the treated area may occur. Additionally, there may be some bruising. These symptoms usually subside in a few hours.
- During the healing process, there is a possibility that the treated area may become either lighter or darker in color compared to the surrounding skin. These conditions are usually temporary and resolve within 2-4 months. Permanent color change is a rare risk.
- In rare cases treatment can result in burning, blistering, infection or scarring but this is a rare occurrence. It is very IMPORTANT to follow up all post-treatment instructions carefully to minimize these chances. If signs of infection develop such as pain, heat or surrounding redness, I have to call DMC at +971 6 556 3553.
- Protective eyewear (shields) will be provided to me during the treatment. I understand that it is my responsibility to keep these shields on at all times during the treatment in order to protect my eyes from injury.
Ratification
- By my signature below, I acknowledge that I have read and fully understand the contents of this informed consent, and that I have had all my questions answered to my satisfaction by DMC registered nurse. I hereby release DMC from all liability associated with this procedure. Furthermore, my signature below indicates my agreement to adhere to all safety precautions and regulations during the treatment.
- I understand that I will always receive the same level of service and professionalism at each visit, but my attending technician may vary. I understand that no refunds will be given for treatments received.
- I have been informed that Photographic documentation of treated area will be taken should I ask for that.
- This consent form is valid for all future laser hair removal sessions performed at DMC.
You have the right to agree to or reject any proposed action at any time before that
For women of childbearing age: I confirm that I am not pregnant. Furthermore, I agree to keep Al Dimashqi Medical Center informed should I become pregnant during the course of treatment.
Patient Name
Patient Signature
Date/Time
Doctor Name
Signature
Date
Patient Signature
Print