• I understand the Q-Switch Laser is an FDA cleared device. I have had time to discuss my indications and the treatment with my Therapist/Doctor and all of my questions have been answered to my satisfaction. I have adequate knowledge of this procedure to sign an informed consent.
• Q-Switch Laser for bleaching fine hair is used mostly on the face and neck, as these types of hair mostly do not respond to Laser Hair Removal Treatments. This treatment may also be used for other body areas.
• Q-Switch laser is used to perform carbon laser or carbon peeling for face and skin, it is a modern technology that uses the Q Switch laser technology with a cream containing carbon particles to perform a deep cleansing of the skin, removing dirt and damaged cells, and returning freshness and vitality to the face and complexion.
• I understand that treatment is contraindicated in patients who are currently taking anti-coagulants, have a compromised immune system, have impaired healing (e.g., keloid scarring tendency), are currently pregnant or breast feeding, have a suspicious lesion in the treatment area and who have had any use of Isotretinoin (Accutane) in the past year.
• I consent to the administration of anaesthesia by my doctor or other qualified staff as needed during the procedure.
• I understand that all anaesthetics involve risks of drug reactions and complications.
• I understand that the Laser is a Class IV Q-Switch Laser. I understand that I must have special laser protective eye shields covering my eyes during treatment. I understand that clinical results may vary depending on my response to this procedure and my compliance with pre and post treatment instructions.
• I also understand that possible complications and risks include scarring, pigment changes, infection, swelling and prolonged redness of the treated skin.
• I understand and will follow the doctor/ therapist recommendations for post treatment care of my skin.
• I understand that no guarantee has been given to me with regard to the percentage of improvement of my skin and that more than one fractional laser skin resurfacing treatment may be necessary to achieve the desired results.

• 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.
• There are no refunds for services rendered and/or after a year from purchase and not used.
• The treatments I receive here are voluntary and I release KAI LIFE CLINIC, my doctors, nurse and/or my technician from liability and assume full responsibility thereof for this appointment and future appointments
• My signature below constitutes my acknowledgment and understanding of all this information.