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PREVIOUS SKIN TREATMENT HISTORY
Have you ever had or are you currently using:
I confirm that all the information I have given is accurate to the best of my knowledge and I will ensure that I advise my practitioner of any changes.
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Laser Tattoo Removal Consent Form
It is a legal requirement that before any clinical procedure the patient reads and signs a consent form. This disclosure is not meant to scare or alarm you; it is simply an effort to make you better informed, so you may give or withhold your consent to the procedure.
have been fully informed by the medical aesthetician and understand the following conditions relating to Laser Tattoo Removal:
• I have answered all the questions regarding my health and skin correctly and to the best of my knowledge, as I am aware that some ailments and medication can affect healing of the skin and response to the laser. It is my responsibility to ensure that I inform my laser operator if I begin a course of medication.
• The cost of treatment has been advised and the specific treatment parameters have been discussed and established. I understand the prices quoted are per treatment.
• I understand that sun exposure and sun beds on the treatment area are not permitted during my treatment course, and application of total sun block must be used if exposure is unavoidable.
• I understand that the last application of fake tan must be at least 2 weeks prior to treatment to ensure no residue is present on the skin.
• Fake tan and natural tan will compromise my treatment either by obliging the operator to reduce the settings to accommodate the tan, or by having to wait for the tan to fade by which time the hair growth cycle will be missed.
• A 50% cancellation fee will be charged if treatment is not suitable due to any kind of tan on the skin.
• It is my responsibility to advise my operator of any exposure to the sun or sun bed before and during the treatment course.
• I understand that failure to do so could have an adverse effect on my skin.
I have discussed, and am aware of the possible side effects of laser treatment as follows:
• Redness, itching and swelling are common side effects immediately after treatment and can sometimes occur up to 2 weeks following treatment
• it is usual and even desirable that there may be a fine, superficial brown scale or gravel rash on the skin the next day. This takes anything from a few days to a couple of weeks before totally disappearing
• hyperpigmentation (increased browning of the skin) may occur especially on darker skin types and may take months to return to normal. In very rare instances, may be permanent
• Folliculitis (infected hair follicles) and acne can be stimulated with the laser especially on male beards, back and chests. Other treatment regions on females as well as males can also be affected
• Bruising and delaying may occur post treatment especially if the skin is susceptible to bruise easily and suffers with circulation problems such as Reynauds Syndrome. If mottling occurs, mild cases may resolve over time, but in some cases it may be permanent.
• There is a slight possibility that if the skin blisters a permanent mark may be left on the skin. Test patches are used to avoid overdosing the area to the extent that they may produce these undesirable effects
• I am aware that I will need to have a test patch for each area I intend on having treated.
• I understand that if I fall pregnant during my treatment course, I will have to discontinue my treatment and re-commence post-pregnancy. I am aware that I will no longer qualify for the guarantee if it is applicable.
• I hereby accept that the essential information necessary to make an informed decision has been given to me.
• I have been fully informed of the risks that may be associated with Laser Tattoo Removal as listed above and have had the opportunity to ask questions relating to the procedure I am about to undergo.
• I understand that no warranty or guarantee has been made to me. It is possible that results might not come up to expectations or goals. We will not be held financially liable provided treatments have been carried out in good faith.
I certify that the practitioner has explained the treatment and that I understand all the statements and information given and I fully understand the treatment programme. I agree and have signed the consent to treatment and accept all terms and conditions.
Tap or click on the signature above to sign
Tap or click on the signature above to sign
Data Protection and Privacy
We are committed to protecting your privacy. We take special precautions with your sensitive personal data and we will process your data lawfully and as described. We only process the data we need for as long as we need to and we respect all of your rights under GDPR. We will never sell, share or otherwise abuse your data. You can contact us at anytime to request your data, change your preferences or request that your data be deleted. GDPR is the European privacy law designed to protect you and give you control of your data.
