Laser Hair Removal Questionnaire

Please read the informed consent below. After you have read this there is a questionnaire to fill out. After reading the acknowledgement please sign if all of your questions have been answered. If they have not please call the facility prior to signing the contract.

  • The purpose of laser hair reduction is to diminish or remove unwanted hair
  • The average person with dark hair needs about 6 treatments to notice a significant difference in the way the hair grows back. There are sometimes a few people that because of other factors whether because of genetics, health, hormonal issues may not respond as well.
  • Test spots may be done for safety or in determining the correct laser settings
  • Dark hair responds best. White, gray, blonde, or red hair will likely not respond
  • Treatment schedule will be 1x per month for the first three treatments. Corresponding visits may be pushed out as hair removal begins to lessen.
  • I understand that laser hair removal is FDA cleared for permanent reduction only and is intended for epilation of hair and that clinical results may vary with different skin types, hair color, and treatment area.
  • Avoidance of sun exposure and the use of Sunblock (30+) is required during full hair removal program in the area(s) being treated.
  • Sensation of the Laser/Coolant varies from client to client. Usually, there is a warming sensation to a rubber band snap.
  • the treated hair should fall out in approximately 2-3 weeks.
  • Cost of treatment is what has been quoted on the website. Prices are subject to change; per treatment prices are slightly higher than package pricing.
  • I understand that there is a possibility of rare side effects such as scarring and permanent discoloration as well as short-term effects such as reddening, irritated raised rash, blistering, mild burning, swelling, bruising, numbing and /or temporary discoloration of the skin.
  • Allergic Reactions: In rare cases, local allergies may cause histamine reaction to the laser. If this is the case, client may choose to take a low dose benadryl before visiting during allergy season.
  • Allergic Reactions II: Local allergies to tape, preservatives used in cosmetics or topical preparation and other things placed on the skin before treatment. Be sure that the area(s) being treated are completely clean.
  • Allergic Reactions III: Systemic reactions may be caused by prescription medications, especially those resulting in photosensitivity. Following is a website with a list of some of those medications: https://www.goodrx.com/blog/avoid-the-sun-if-you-take-these-drugs/ ( be sure to come back to finish your form).
  • I will be given protective eyewear in treatment. I understand that it is my responsibility to keep the eyewear on to protect my eyes from possible injury from the laser light source.
  • Compliance with the aftercare instructions is crucial for healing, prevention of scarring, and hyperpigmentation

Pre-Care: Shaving the area(s) before coming for scheduled treatments is necessary. A $15.00 shaving fee is charged if the technologist has to shave the area(s) being treated. PLEASE notify the facility if you have had any medication changes in between visits, especially anti-biotics. Drinking 40 oz. of water per day for at least two days leading up to visits is important for ease and comfort of treatment.

Aftercare: You will likely have some redness and slight erythema directly following treatment along with small bumps where each hair follicle was exposed to the laser light. It is important to keep the area(s) out of the sun for up to and beyond 7 days post & Pre treatment. You can apply aloe vera for up to 24 hours after treatment in facility. (Any ointments should be organic and free of alcohol or fragrances that can be irritating to the treatment areas.) No hot tubbing, laying out in the sun, hot sitz baths or exposing the areas to clothing that traps heat. You may want to take a day off of the gym or strenuous sports or training schedules. The redness or swelling that occurs will dissipate within 20 minutes to 24 hours depending on the size of the area(s). I understand that lasers emit a tremendous amount of energy to the skin, and that it is my responsibility to follow the guidelines.

NO SHOW & Late Cancellation policy: We prefer a 24-48 hour notice to cancel an appointment. No shows will accrue a $50 fee to be paid before further treatments occur. Late cancellation in under 24 hrs must reschedule within 1 week of cancellation or a $25 fee will be accrued.

Acknowledgements:

My questions regarding the procedure have been answered satisfactorily. I understand the procedure(s) and risks and accept them both. I hereby release the technician, technologist, the staff, the medical director, the companies from all liabilities associated with the procedure(s) I may undergo. I have been informed of the aftercare instructions and the no show cancellation policy and will comply with them.