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 Exposure – Protective 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.
-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