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We strive to provide the best appropriate medical care for all patients requiring aesthetic medical treatments, please can you help indicate by completing the following section your reason for requiring aesthetic medical treatment.
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.
Tap or click on the signature above to sign
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CONSENT FORM LASER HAIR REMOVAL
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 hair reduction:
• 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 am aware that no waxing, plucking, threading or any method that involves removing hair by the root is acceptable throughout my treatment course. Shaving is acceptable.
• For optimum results all treatments must be done within 2 weeks of first noticing new re-growth or within 3 months (whichever the sooner). I understand the difference between new hairs and treated hair casts
• For optimum results, I will need to have a minimum 6 treatments at the recommended settings. If the power is set lower at my request, I understand that the treatment may not be as effective.
• I am aware that I will need to be re-test patched on the area if I don’t return to the clinic within 6-month period. I also understand that I will need to have a test patch on any new area I am considering for treatment.
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.
• In rare circumstances, it has been known for laser hair removal to stimulate hair growth in surrounding areas. If this occurs, it may be necessary to discontinue treatment and discuss alternative methods of permanent reduction
• 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 the initial test patch will cost £25 However, I will not be charged for any subsequent test patches I may require in the future.
• 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.
• CANCELLATION POLICY – If for any reason I fail to attend my appointment I agree to the following cancellation policy;
• Less than 48 hours’ notice – 25% of fee
• Less than 24 hours’ notice – 50%
• Non-Attendance – 70% of fee or loss of course item
• 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 hair 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 as a result or cure. 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 understand the treatment involves a course of treatments. The fee structure has been fully explained and I understand that I am required to pay for a course of treatments prior to any procedures taking place or as agreed plan set during consultation, I am fully aware that should I wish to cancel the course the outstanding treatment value is non-refundable.
I certify that the practitioner has explained the need for these medical aesthetic treatments 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.
