The Procedure and You:
The concept of using electric current for hair removal has been available since the late 1800’s, has been
improving ever since. Electrolysis treatments are a form of electrical epilation where a single use,
disposable wire filament is inserted into the hair follicle (a natural opening in the skin) and a minimal
amount of current is delivered to the root of follicle to destroy it through a variety of modalities. All
modalities will affect only the active hair follicle making this a direct route to target unwanted hair.
It is imperative that we treat hairs in the correct cycle. The desired stage is when hairs are first growing.
Before Your Treatment:
• If you are going to be treating sun-exposed areas, apply sunblock (at least SPF 50) each morning for
one month before treatment.
• Refrain from bleaching, plucking. Threading, electrolysis or waxing of hairs in desired treatment
area for six weeks when at all possible. Its fine to cut, shave or trim the area.
• If you have a history of herpes or cold sores, you may need antiviral medication. This medication
should be started one day before laser treatment and continued for one week after treatment.
• The area for treatment needs to have the hair showing to a short stubble or longer
• Arrive with the treatment area clean and free of makeup (if treating the face) if possible.
Post Treatment Care:
• Treat the area gently by keeping the skin moist with Aquaphor healing ointment for a few days.
Your skin heals from the bottom up so this assists with healing.
• Cleanse the area with a mild antiseptic such as 70% isopropyl alcohol, witch hazel, or sea breeze
and avoid using soaps or abrasive material when you are 24 hours post treatment.
• Do not pick, rub or scratch the area. Do not use any irritating substance on the treated area until
the skins return to normal.
• If the treated area will be exposed to sun, apply SPF 50 or greater after the skin returns to normal.
• If your face was treated, you may resume using clean make up when the skin
looks and feels back to normal.
• As part of your electrolysis appointment, we do a very thorough after care procedure.
• You may follow your usually cleaning or make up routine. If there are anu issues, please call us
• Please use the frozen pack that er give you as part of the aftercare treatment as you leave our
office.
Acknowledgement:
I understand that the treatment is now guaranteed due to risks of complications, both known and
unknown to the technician and my self.
I understand that the result is reliant on the accuracy of information I have to provide Enfield Royal Clinic
LLC regarding my medical history and my adherence to proper before and after care.
I understand that possible side effects may include, but are not limited to:
• Inflammation of the hair follicle
• Edema (Swelling)
• Purpura (Bruising)
• Redness directly after treatment
I understand that the frequency and longevity of treatment is determined solely by my body’s natural hair
growth and therefore not predetermined.
I acknowledge that I read, understand and accept the terms above in regards to electrolysis hair removal
treatment. I Hereby consent to and authorized
to perform electrolysis hair removal
treatment and related before and after treatment services on me.
I understand and agree that I am financially responsible for the payment I made for
that any amount I paid for the sessions or procedures I booked it will only be valid up to 3 months from the
date I made the payment. I understand that I need to utilize the sessions or procedures within 3 months
period. I agree that my payment made is non-refundable or non-transferable post this period.
I declare that I have read and fully understood all points in this consent and that all of my questions were
answered to my satisfaction and I take the full responsibility of my decision in this consent.
Patient Name & Signature :
Doctor/Therapist Name & Signature :
Witness Name & Signature :
Parent or Gaurdian Name (if patient is minor) :
Date :
Consent to be photographed and published
I, , consent to be photographed and published on Social
media, by while before and after the procedure. I further authorize that the
photographs may be published for any purpose and in any form.
