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LASER HAIR REMOVAL CONSENT FORM

LHR is a non-invasive laser treatment designed to temporarily remove unwanted hair from different/ all parts of the body.

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 line) there is no guarantee to have a straight neck line. Time between each session is necessary.
The hairs will not necessarily 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 or/and after a year from purchase and not used.
Choice of suitable laser machine for the treatment is done by the doctor/ laser technician.

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.
I have had the opportunity to ask questions, and all my questions have been answered to my satisfaction.
I declare that while completing the medical questionnaire, I have answered the information related to my personal medical history questions completely and I have not withheld any information.
I 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.

I hereby authorize and direct the doctors and/or technician to perform the treatment on me.

Patient Name

Patient Signature

Date/Time

Doctor Name

Signature

Date

Witness Name

Witness Signature