Laser Hair Removal Consultation/Consent Form | Aesthetics Forms Portal

Laser Hair Removal Consultation and Consent Form

Name: *

Date of Birth: *

Contact Number: *

Email: *

Medical History

Are you currently taking any medication? *

Please specify/give details, including dates/frequency of medication: *

Do you have any allergies or intolerances? *

Please specify: *

Do any of the following apply to you? Please tick all that apply.

Are you currently (or possibly may be) pregnant? *

Do you have any other medical conditions? *

Please specify: *

Have you recently been unwell? *

Which of the following have you been unwell with? *

Please provide more detail: *

Emergency Contact Details

Emergency Contact Name: *

Emergency Contact Relationship: *

Emergency Contact Phone: *

Consultation

Please tick the area(s) to be treated: *

Legs Armpits Upper Lip Chin Bikini Line Other

If Other, Please specify: *

Fitzpatrick skin types:

1) Very pale white skin, often with green or blue eyes and fair or red hair - burns without tanning

2) White skin, often with blue eyes - burns and does not tan easily

3) Fair skin with brown eyes and brown hair - burns first then tans

4) Light brown skin, dark eyes, and dark hair - burns a little and tans easily

5) Brown skin, dark eyes, and dark hair - easily tans to a darker color and rarely burns

6) Dark brown or black skin, dark eyes, and dark hair - never burns but tans darker

Which of the above skin types best describes your skin? *

Do you have any tattoos? *

Tanning History (Direct sun, Self-tanners, Spray tans etc.). Please list and include last date of use: *

Have you previously had laser hair removal? *

Previous Laser Treatment(s) - If known, please specify date, number of treatments, frequency, response to treatment, device used: *

Have you previously used any of the following hair removal methods? *

Frequency and last use of above: *

Do you use sunscreen? *

Do you smoke? *

Treatment Information

How does Laser Hair Removal work?
The laser emits light energy, which is absorbed by melanin in the hair. If in the right stage of growth, this causes the hair follicle to overheat and damages the bulb, preventing regrowth. The process is called photothermolysis.

Does it hurt?
Laser Hair Removal is described as feeling like the flick of an elastic band. The more sessions you have, the less pain you feel as there are fewer hair follicles targeted.

Is it safe?
Absolutely, laser hair removal is safe. The laser targets only the hair follicle, leaving the surrounding skin unharmed.

What results can I expect?
Hair growth has many factors and hormones play a big part in hair growth, so top up treatments to maintain the reduction may be required but it is worth it to keep the skin smooth and the hair reduce and slow growing- especially if you suffer from ingrown hairs.

Potential Side Effects

A few side effects can appear after laser hair removal. Most side effects are minor and temporary. Serious complications related to laser hair removal are rare. Anyone experiencing lasting side effects should seek medical advice.

Redness and irritation
Laser hair removal damages the follicles of the targeted hairs. The body reacts to this, and many people experience redness and irritation in the affected areas. The skin may tingle or feel tender, and may even appear to swell slightly. The symptoms are usually short-lived. The affected area may look similar to skin that has just been waxed or plucked. Irritation should ease after the initial reaction, usually within a few hours of the treatment. Swelling and redness may respond well to ice packs or a cool bath.

Crusting
Some people may experience skin crusting in the affected area. This is typically a minor issue but can be inconvenient. Crusting can sometimes lead to scabbing or scarring. By taking care of the treated area after laser removal, such as by using a moisturizer, a person may prevent any lasting issues from this treatment.

Changes in skin color
Some people may notice minor color changes to the treated area of skin. It may get slightly darker or lighter, following laser hair removal. People with lighter skin may be more likely to experience darker pigmentation changes. People with darker skin tones may be more prone to lighter pigmentation changes. These changes tend to fade away over time, and the skin returns to normal.

Eye injury
The hair removal procedure involves the use of powerful lasers. This means there is a risk of potentially serious eye injury, especially if the procedure is carried out on, or near, the face. Both the person receiving the treatment and the practitioner should wear protective eye equipment to help prevent injury while the procedure is carried out.

Risk of skin infection
As with other cosmetic hair removal methods, damaging hair follicles with a laser can create an infection risk. The affected area should be treated as a wound while it heals. Please seek medical advice for any sign(s) of infection.

Aftercare Advice

The recovery time after the procedure is minimal and most patients can return to life as normal directly after.

Wearing sunscreen after the procedure is important as this will help prevent further irritation.

You can expect to see a reduction in the number of hairs in the treated area immediately after the procedure. 2-8 weeks after laser hair removal, you may begin to notice an increase in hair growth in the treated area. The reason for this is that not all hair follicles respond equally to the laser.

Most patients see a 10-25% reduction in hair after the first treatment.

It typically takes between 3 and 8 sessions for permanent hair loss. The evaluation with your specialist before the procedure will give you a better idea of how many treatment sessions you may need. Also, you will likely need a touch-up session yearly to maintain effect.

Please tick the box to confirm: *

I have read and understood the aftercare advice given to me on this form.

Consent

I accept that any treatment I am going to receive is at my own risk.

I certify that I have read and fully understood and completed this form to the best of my knowledge.

I understand that failure to disclose information requested above may result in adverse side effect(s) and therefore I accept full liability/responsibility for the information given.

The treatment(s) and possible side effect(s) have been fully explained to me.

I accept full responsibility for the treatment given and complications which may arise or result during or following any procedure that is performed at my request.

I accept that if I am not satisfied with the treatment I will inform the therapist and/or request to speak to the manager during or immediately following the treatment.

I fully understand the above and consent to receive Laser Hair Removal treatment(s).

Client Signature: *

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