Intense Pulsed Light (IPL) Consent Form
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| Are you suffering from fever? |
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| Do you have low immune system? |
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| Do you have poor health? |
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| Are you pregnant? |
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| Are you suffering or have suffered from skin cancer? |
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| Are you diabetic? |
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| Do you suffer from epilepsy? |
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| Do you wear any artificial tan? |
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| Have you been exposed to direct sunlight recently? (without sun block) |
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| Do you suffer from Hirsutism? |
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| Have you had any laser resurfacing or chemical peels recently? |
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| Do you suffer from Herpes Simplex? |
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| Do you scar easily? |
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| Do you have a blood disorder? |
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| Are you taking any anti-coagulant (blood thinning) medicine? |
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| Are you taking any medication for acne treatment? |
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| Are you taking any steroids or antibiotics? |
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• IPL treatments remove hair in the growing stage only. Hence, there are several treatments required to achieve satisfactory results.
• IPL treatments may not lead to a complete hair removal, but mainly to hair reduction.
• IPL treatments may cause hyper or hypopigmentation of the skin.
• There is a chance of skin reddening, which usually disappears within hours or a few days.
• There is a small risk of blister formation, which will heal within a few days.
• The patient must follow all the advice given by the clinic for post treatment care.
• The patient must complete the above questionnaire truthfully and completely.
• Hormonal changes and stress may lead to regrowth of any removed hair.
I confirm that the above points have been explained to me and that I have fully read and understood them. I am happy to proceed with treatments.
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.
