LASER AND IPL CONSENT FORM

I hereby authorize MedSpa at Villagio  to perform light based hair reduction on me. By Signing below, I understand that:

-This procedure works on the growing hairs and not on dormant hairs. 

-I will require several treatments to obtain a significant, long-term reduction of hair growth.

-I may experience fewer, thinner, lighter, slower re-growth of hairs, temporary hair loss or permanent hair reduction. 

-It is only effective on hair with color and does not treat white, grey, blond, or red hair. 

-Genetics, hormones, medication and hair color may interfere with hair loss and I may not respond at all.

 

In very rare cases, the procedure may result in the following adverse experiences or risks:

 

-Discomfort or pain             -Redness or short-term swelling                       -Change in skin color                           -Wounds

-Infection                               -Temporary or permanent gray hair                -Paradoxical hair growth                    -Scarring

 

If any of the aforementioned occur, please call our office!

 

Eye ExposureProtective eyewear will be provided to you during the treatment.  Failure to wear eye shields during the entire treatment may cause severe and permanent eye damage.

Sun Exposure / Tanning Beds / Artificial Tanning – May increase risk of side effects and adverse events. Avoid sun exposure of treatment area for 2 weeks prior to treatment.

 

I acknowledge the following points have been discussed with me:

  • Potential benefits of the proposed procedure, including the possibility that the procedure may not work for me
  • Alternative treatments such as electrolysis, waxing, plucking and depilatories
  • Reasonably anticipated health consequences if the procedure is not performed
  • Possible complications/risks involved with the proposed procedure and subsequent healing period

 

For women of childbearing age: By signing below I confirm that I am not pregnant and do not intend to become pregnant anytime during the course of treatment. Furthermore, I agree to keep MedSpa at Villagio  informed should I become pregnant during the course of treatment.

 

AFTERCARE INSTRUCTIONS:

-Limit sun exposure of treated area for a week             -Resume your workout schedule the day after your treatment

-If area is sensitive apply some Aloe Vera                       -Do not pluck/wax area, only shave if needed