Laser Treatment Information and Consent
I accept to undergo a Hair Removal / Vein Removal / Acne Clearance / Photo Rejuvenation / Skin Resurfacing / Onychomycosis Treatment / Pigmentation Treatment / Wart Treatment / Tattoo Removal treatment or course.
Contraindications
- Pregnancy (or planning pregnancy)
- Sun Exposure, sunbeds or fake tan
- Pigmentary Skin Conditions (e.g. melasma, vitiligo)
- History of cancer (or chemo/radiotherapy)
- Diabetes (Type 1 or Type 2)
- Epilepsy
- Lymphatic/Autoimmune Disorders (e.g. Lupus, Rheumatoid Arthritis)
- Communicable Diseases (Hepatitis/HIV)
- PCOS/Hormonal Imbalance
- Thyroid Conditions
- Psoriasis/Eczema or other skin conditions
- Herpes (Shingles/Cold Sores)
- High or Low Blood Pressure
- Photosensitive Conditions
- Allergies
I have informed my practitioner about any contra-indications listed above that affect me and I understand that withholding information can result in a LASER/IPL injury.
Possible complications have been discussed with me and any questions I have regarding the treatment have been answered to my satisfaction.
I can confirm that I am not pregnant and that the information I have provided is correct.
Laser Treatment Consent Form
I understand that the result of the treatment is not guaranteed and results may not be obtained.
I agree to adhere to all safety precautions and regulations during the treatment. I understand that I am under obligation to inform the clinic of any changes in my health or medications prior to each treatment.
I am aware of the cost of the procedure and that full payment is expected at the time of service. I am also aware that no procedure fees can be refunded in the case of a suboptimal result or complication as all fees paid are entirely in respect of the service provided, i.e., professional time, expertise, product costs and other costs incurred by the clinic in providing the procedure and such costs are incurred independently of the results achieved.
Additional costs may occur should complications arise from the procedure.
